Healthcare Provider Details

I. General information

NPI: 1558909127
Provider Name (Legal Business Name): DANIELLE SHEPPARD LPCC, BC-TMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2019
Last Update Date: 12/14/2019
Certification Date: 12/14/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 BEVERLY BLVD
LOS ANGELES CA
90004-3539
US

IV. Provider business mailing address

4131 LAFAYETTE PL
CULVER CITY CA
90232-2817
US

V. Phone/Fax

Practice location:
  • Phone: 323-369-6888
  • Fax:
Mailing address:
  • Phone: 323-369-6888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License NumberLPCC444
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC444
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC444
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberLPCC444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: