=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255593695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARPER FUTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2008
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 870 MARKET ST STE 1275
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-397-6622
-----------------------------------------------------
Fax | 415-397-6666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 870 MARKET ST STE 1275
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94102-2918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-397-6622
-----------------------------------------------------
Fax | 415-397-6666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FORENSIC PSYCHOTHERAPIST
-----------------------------------------------------
Name | SHANA LINDSAY BURNS
-----------------------------------------------------
Credential | M.A., MFTI
-----------------------------------------------------
Telephone | 415-397-6622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | IMF50099
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------