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NPI Code Detail

MEDICARE: JEFFERY ALLEN SHEPHERD

MEDICARE: JEFFERY ALLEN SHEPHERD
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669149720
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFERY ALLEN SHEPHERD
Provider Business Mailing Address
First Line : 827 MCKAIG AVE
Second Line :
City : TROY
State : OH
Zip : 45373-2951
Country : US
Telephone Number : 937-668-6723
Fax Number :
Provider Business Practice Location Address
First Line : 1628 SPRINGFIELD ST
Second Line :
City : DAYTON
State : OH
Zip : 45403-1430
Country : US
Telephone Number : 937-802-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2021
Last Update Date : 08/26/2021

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