Healthcare Provider Details

I. General information

NPI: 1003979956
Provider Name (Legal Business Name): JOANN SHEPHERD MA, CDP, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9706 4TH AVE NE
SEATTLE WA
98115-2157
US

IV. Provider business mailing address

1600 E OLIVE ST SOUND MENTAL HEALTH
SEATTLE WA
98122-2735
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-2900
  • Fax: 206-302-2910
Mailing address:
  • Phone: 206-302-2200
  • Fax: 206-302-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCP00002245
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00005465
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: