Provider Demographics
NPI:1104995190
Name:BYNUM, SHARON KAY (MED, LPC, LADC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:BYNUM
Suffix:
Gender:F
Credentials:MED, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 CROOKED OAK DR.
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026-0853
Mailing Address - Country:US
Mailing Address - Phone:405-364-7817
Mailing Address - Fax:405-366-8835
Practice Address - Street 1:A RENEWAL CENTER, 2202 WESTPARK DR.
Practice Address - Street 2:SUITE A
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4032
Practice Address - Country:US
Practice Address - Phone:405-364-6500
Practice Address - Fax:405-364-6501
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK269101YA0400X
OK262101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional