MEDICARE: BERNARD SHARKUS M.ED., 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	LPC-1346	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPC-1346	OTHER	AZ	LICENSED COUNSELOR

General Provider Information

NPI Number	:	1962566372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD SHARKUS M.ED., LPC

Provider Business Mailing Address
First Line	:	4400 E BROADWAY BLVD
Second Line	:	SUITE 704
City	:	TUCSON
State	:	AZ
Zip	:	85711-3517
Country	:	US
Telephone Number	:	520-327-6081
Fax Number	:	520-327-7699

Provider Business Practice Location Address
First Line	:	4400 E BROADWAY BLVD
Second Line	:	SUITE 704
City	:	TUCSON
State	:	AZ
Zip	:	85711-3517
Country	:	US
Telephone Number	:	520-327-6081
Fax Number	:	520-327-7699

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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