Healthcare Provider Details

I. General information

NPI: 1265690499
Provider Name (Legal Business Name): REL VINCENT SHARP LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E TAYLOR ST SUITE 4011
SHERMAN TX
75090-2881
US

IV. Provider business mailing address

600 E TAYLOR ST SUITE 4011
SHERMAN TX
75090-2881
US

V. Phone/Fax

Practice location:
  • Phone: 903-375-3358
  • Fax: 903-892-6323
Mailing address:
  • Phone: 903-375-3358
  • Fax: 903-892-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62436
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: