MEDICARE: DR. MICHAEL S. SHEPARD 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
1	103T00000X	Psychologist	PY0540	NV
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PY0540	NV
3	103TA0700X	Adult Development & Aging Psychologist	PY0540	NV
4	103TB0200X	Cognitive & Behavioral Psychologist	PY0540	NV
5	103TC0700X	Clinical Psychologist	PY0540	NV
6	103TE1100X	Exercise & Sports Psychologist	PY0540	NV
7	103TH0004X	Health Psychologist	PY0540	NV
8	103TH0100X	Health Service Psychologist	PY0540	NV
9	103TP2701X	Group Psychotherapy Psychologist	PY0540	NV

General Provider Information

NPI Number	:	1942474937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL S. SHEPARD PSY.D.

Provider Business Mailing Address
First Line	:	2775 S JONES BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5631
Country	:	US
Telephone Number	:	702-326-5390
Fax Number	:	702-586-3333

Provider Business Practice Location Address
First Line	:	2775 S JONES BLVD
Second Line	:	SUITE 101
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5631
Country	:	US
Telephone Number	:	702-685-3300
Fax Number	:	702-586-3333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2008
Last Update Date	:	06/07/2012

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