Healthcare Provider Details

I. General information

NPI: 1740119981
Provider Name (Legal Business Name): KRISTINA MARIE SHEPPARD LCSW
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 W THUNDERBIRD RD STE E454
GLENDALE AZ
85306-4646
US

IV. Provider business mailing address

2850 N COUNTRY CLUB RD
TUCSON AZ
85716-1910
US

V. Phone/Fax

Practice location:
  • Phone: 480-870-3010
  • Fax: 480-716-6990
Mailing address:
  • Phone: 520-322-6274
  • Fax: 520-509-4496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23793
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: