=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407246911
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHARP COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2015
-----------------------------------------------------
Last Update Date | 02/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 N MAIN ST E
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83204-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-251-9779
-----------------------------------------------------
Fax | 855-311-0609
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 N MAIN ST E
-----------------------------------------------------
City | POCATELLO
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83204-3113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-251-9779
-----------------------------------------------------
Fax | 855-311-0609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PROVIDER
-----------------------------------------------------
Name | MS. LINDA C SHARP
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 208-251-9779
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | LCSW 877
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------