Healthcare Provider Details

I. General information

NPI: 1477577641
Provider Name (Legal Business Name): JUNE ELLEN SHEPHERD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MENTAL HEALTH CLINIC, 27 TH SPECIAL OPERATIONS GROUP 208 CASABLANCA
CANNON AFB NM
88103-5014
US

IV. Provider business mailing address

1105 CALHOUN ST.
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-784-1108
  • Fax:
Mailing address:
  • Phone: 512-789-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24847
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: