MEDICARE: SHARON DURHAM

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	73562	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265981039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON DURHAM

Provider Business Mailing Address
First Line	:	5904 S COOPER ST STE 104-162
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4494
Country	:	US
Telephone Number	:	817-719-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	5904 S COOPER
Second Line	:	STE 104-PMB-162
City	:	ARLINGTON
State	:	TX
Zip	:	76017-7601
Country	:	US
Telephone Number	:	682-331-2685
Fax Number	:

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

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	10/13/2020

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