Basic Information
| Provider Information | |||||||||
| NPI: | 1053886952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHARP | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | NICHOLE | ||||||||
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| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3663 W CACTUS AVE UNIT 3120 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891418894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028612135 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5940 S RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891182506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885318385 | ||||||||
| FaxNumber: | 9252641902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2018 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | LBA0527 | NV | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1053886952 | 05 | NV | MEDICAID | 15117250 | 01 | CAQH | OTHER |