Provider Demographics
NPI:1124344791
Name:NASH, SHARON GROSS (MFT)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:GROSS
Last Name:NASH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 HALL RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-9642
Mailing Address - Country:US
Mailing Address - Phone:831-431-3894
Mailing Address - Fax:
Practice Address - Street 1:4835 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2428
Practice Address - Country:US
Practice Address - Phone:831-818-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist