Healthcare Provider Details

I. General information

NPI: 1306961701
Provider Name (Legal Business Name): TONI ANN SHEPPARD LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 BENTON RD
BOSSIER CITY LA
71111-7933
US

IV. Provider business mailing address

2285 BENTON RD
BOSSIER CITY LA
71111-7933
US

V. Phone/Fax

Practice location:
  • Phone: 318-455-8995
  • Fax:
Mailing address:
  • Phone: 318-455-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2687
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number656
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: