MEDICARE: SHAROLYN M STANLEY LPC, MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	63465	TX

General Provider Information

NPI Number	:	1083206577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAROLYN M STANLEY LPC, MA

Provider Business Mailing Address
First Line	:	811 OAK SHADOWS RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4226
Country	:	US
Telephone Number	:	832-971-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 OAK SHADOWS RD
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4226
Country	:	US
Telephone Number	:	832-971-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2021
Last Update Date	:	02/06/2021

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