Provider Demographics
NPI:1912482829
Name:STARKS, SHERARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:SHERARD
Middle Name:
Last Name:STARKS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 NW 73RD TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1682
Mailing Address - Country:US
Mailing Address - Phone:816-352-7812
Mailing Address - Fax:816-466-5374
Practice Address - Street 1:403 NW 73RD TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-1682
Practice Address - Country:US
Practice Address - Phone:816-352-7812
Practice Address - Fax:816-466-5374
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018011512104100000X
TX1084211041C0700X
IN34010043A1041C0700X
MO20200276431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018011512OtherLICENSE