Provider Demographics
NPI:1962768549
Name:PARADISE, SHARYN (SKY) A (LPCC)
Entity type:Individual
Prefix:DR
First Name:SHARYN (SKY)
Middle Name:A
Last Name:PARADISE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-1245
Mailing Address - Country:US
Mailing Address - Phone:575-519-0489
Mailing Address - Fax:
Practice Address - Street 1:508 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-4925
Practice Address - Country:US
Practice Address - Phone:575-519-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-08
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0148691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional