Provider Demographics
NPI:1124322904
Name:SHARON JONES-FORRESTER, PHD, PC
Entity type:Organization
Organization Name:SHARON JONES-FORRESTER, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES-FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-510-6502
Mailing Address - Street 1:716 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-6922
Mailing Address - Country:US
Mailing Address - Phone:702-382-1960
Mailing Address - Fax:702-382-4993
Practice Address - Street 1:716 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-6922
Practice Address - Country:US
Practice Address - Phone:702-382-1960
Practice Address - Fax:702-382-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0614103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty