MEDICARE: BRIAN LEE SHARP LPC

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	66868	TX

General Provider Information

NPI Number	:	1114264587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN LEE SHARP LPC

Provider Business Mailing Address
First Line	:	4615 WALZEM RD
Second Line	:	STE 208
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1667
Country	:	US
Telephone Number	:	210-267-8993
Fax Number	:	210-267-9243

Provider Business Practice Location Address
First Line	:	4615 WALZEM RD
Second Line	:	STE 208
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-1667
Country	:	US
Telephone Number	:	210-267-8993
Fax Number	:	210-267-9243

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

Provider Enumeration Date	:	01/05/2013
Last Update Date	:	09/13/2013

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