Healthcare Provider Details

I. General information

NPI: 1881924645
Provider Name (Legal Business Name): NATALIE ELRISSA SHEPHERD LPC, LMFT, RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2009
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E RL THRTN FWY SUITE 503
DALLAS TX
75228-7018
US

IV. Provider business mailing address

1155 POTTER AVE
ROCKWALL TX
75087-2419
US

V. Phone/Fax

Practice location:
  • Phone: 214-770-3029
  • Fax: 214-319-9209
Mailing address:
  • Phone: 972-771-6928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number18113
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number5105
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: