Provider Demographics
NPI:1962566372
Name:SHARKUS, BERNARD (MED, LPC)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:SHARKUS
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 E BROADWAY BLVD
Mailing Address - Street 2:SUITE 704
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3517
Mailing Address - Country:US
Mailing Address - Phone:520-327-6081
Mailing Address - Fax:520-327-7699
Practice Address - Street 1:4400 E BROADWAY BLVD
Practice Address - Street 2:SUITE 704
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3517
Practice Address - Country:US
Practice Address - Phone:520-327-6081
Practice Address - Fax:520-327-7699
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1346101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLPC-1346OtherLICENSED COUNSELOR