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General NPI Number Information
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NPI Number | 1295021277
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Entity Type | Individual
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Provider Name | SHARON RUTH LANK MSW, MT-BC
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Gender | Female
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 06/28/2011
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Provider Practice Location Address
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Address Line | 2555 E COLORADO BLVD STE 100-101
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City | PASADENA
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State | CA
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Zip | 91107-6622
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Country | US
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Telephone | 626-577-2261
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Fax | 626-577-2543
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Provider Business Mailing Address
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Address Line | 246 CAMELLIA LANE APT. B
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City | COSTA MESA
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State | CA
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Zip | 92627
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Country | US
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Telephone | 714-875-5429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW26407
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License Number State | CA
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