Healthcare Provider Details

I. General information

NPI: 1205977527
Provider Name (Legal Business Name): SHEPARD HOUSE COUNSELING & PSYCHOLOGICAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 MAIN ST
SAINT JOSEPH MI
49085-1426
US

IV. Provider business mailing address

PO BOX 679
SAINT JOSEPH MI
49085-0679
US

V. Phone/Fax

Practice location:
  • Phone: 269-985-2000
  • Fax: 269-985-2002
Mailing address:
  • Phone: 269-985-2000
  • Fax: 269-985-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. ANDREW KATOVSICH
Title or Position: PRESIDENT & PRACTICE MANAGER
Credential: MA, LLP
Phone: 269-985-2000