Healthcare Provider Details

I. General information

NPI: 1922982685
Provider Name (Legal Business Name): KATELYN LEE SHEPARD MSPS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N BROADWAY AVE STE 106
ADA OK
74820-5049
US

IV. Provider business mailing address

10215 COUNTY ROAD 3440
STRATFORD OK
74872-5302
US

V. Phone/Fax

Practice location:
  • Phone: 580-235-3967
  • Fax:
Mailing address:
  • Phone: 580-235-3967
  • Fax: 580-235-3967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11543
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: