Basic Information
| Provider Information | |||||||||
| NPI: | 1962411645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENT | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | RUTH | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 CHARLOTTE ST | ||||||||
| Address2: | RM # 214 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045804 | ||||||||
| FaxNumber: | 8164045845 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 CHARLOTTE ST | ||||||||
| Address2: | RM # 214 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8164045804 | ||||||||
| FaxNumber: | 8164045845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 101 Y00000X | MO | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 000459 | MO | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.