MEDICARE: MRS. SHARON KAY WHITLEY LCSW

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	104100000X	Social Worker	19576	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	:	1902846397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON KAY WHITLEY LCSW

Provider Business Mailing Address
First Line	:	16107 DIANA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-4408
Country	:	US
Telephone Number	:	361-655-7719
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 BAY AREA BLVD STE 122B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2505
Country	:	US
Telephone Number	:	361-655-7719
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	08/02/2020

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