MEDICARE: DR. JEREMY THOMAS SHARP PH.D.

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	103TC1900X	Counseling Psychologist	3349	CO

General Provider Information

NPI Number	:	1821323676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY THOMAS SHARP PH.D.

Provider Business Mailing Address
First Line	:	3500 JOHN F KENNEDY PKWY
Second Line	:	STE 200
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2635
Country	:	US
Telephone Number	:	970-420-7919
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 JOHN F KENNEDY PKWY
Second Line	:	STE 200
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2635
Country	:	US
Telephone Number	:	970-889-8204
Fax Number	:	888-494-3756

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

Provider Enumeration Date	:	10/13/2009
Last Update Date	:	05/15/2019

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