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NPI Code Detail

MEDICARE: DR. BETHYL JOY SHEPPERSON PSY.D.

MEDICARE: DR. BETHYL JOY SHEPPERSON PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY-1717HI

General Provider Information

NPI Number : 1598813701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BETHYL JOY SHEPPERSON PSY.D.
Provider Business Mailing Address
First Line : PO BOX 4938
Second Line :
City : KAILUA KONA
State : HI
Zip : 96745-4938
Country : US
Telephone Number : 808-329-7176
Fax Number : 808-326-1279
Provider Business Practice Location Address
First Line : 1619 E CHAPMAN AVE
Second Line :
City : FULLERTON
State : CA
Zip : 92831-4015
Country : US
Telephone Number : 714-992-4240
Fax Number : 714-992-5259
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2007
Last Update Date : 11/27/2019

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