Provider Demographics
NPI:1871561548
Name:PUGH, SHARON ANNE (PHD, MP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:ANNE
Last Name:PUGH
Suffix:
Gender:F
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2450
Mailing Address - Country:US
Mailing Address - Phone:318-308-1319
Mailing Address - Fax:
Practice Address - Street 1:5016 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2450
Practice Address - Country:US
Practice Address - Phone:318-308-1319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA906103TC0700X
LAMP0906103TP0016X
LAMPAP000034103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4C278Medicare PIN