Provider Demographics
NPI:1871132795
Name:VAN RY, SHARON ANN (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
Last Name:VAN RY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 RODEO CIR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-9764
Mailing Address - Country:US
Mailing Address - Phone:254-319-0443
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP STE 2
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5061
Practice Address - Country:US
Practice Address - Phone:254-553-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67665101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty