Provider Demographics
NPI:1225495302
Name:HART, SHARLA (MA,VC)
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:MA,VC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOMESTEAD RD APT 5
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5709
Mailing Address - Country:US
Mailing Address - Phone:504-255-2890
Mailing Address - Fax:
Practice Address - Street 1:100 HOMESTEAD RD APT 5
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5709
Practice Address - Country:US
Practice Address - Phone:504-255-2890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA005899825101YP2500X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA$$$$$$$$$OtherMEDICAID ISSUING STATE