Provider Demographics
NPI:1053405407
Name:CARL, SHARON ANN (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:CARL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17431 N 71ST DR STE 103
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8598
Mailing Address - Country:US
Mailing Address - Phone:602-633-2246
Mailing Address - Fax:602-687-7069
Practice Address - Street 1:17431 N 71ST DR STE 103
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8598
Practice Address - Country:US
Practice Address - Phone:602-633-2246
Practice Address - Fax:602-687-7069
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1003101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-1003OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS
AZS-1642OtherASSOCIATION FOR PLAY THERAPY
AZ649014OtherAHCCCS PROVIDER NUMBER