Basic Information
| Provider Information | |||||||||
| NPI: | 1659664464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LII | ||||||||
| FirstName: | SHARON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1663 MISSION ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941032485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772646747 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9221 SW BARBUR BLVD STE 305 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972195421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772646747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2011 | ||||||||
| LastUpdateDate: | 08/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103K00000X | 1-15-20877 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
ID Information
| ID | Type | State | Issuer | Description | 1659664464 | 01 | CA | NPI | OTHER |