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General NPI Number Information
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NPI Number | 1003521907
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Entity Type | Organization
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Legal Business Name | CYNTHIA SHEPHERD, LCSW, LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 15615 STATE ROAD 23 STE D
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City | GRANGER
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State | IN
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Zip | 46530-7091
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Country | US
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Telephone | 574-406-0190
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Fax |
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Provider Business Mailing Address
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Address Line | 51720 BLUFFSIDE CT
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City | GRANGER
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State | IN
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Zip | 46530-7054
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Country | US
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Telephone | 574-274-9944
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MRS. CYNTHIA SHEPHERD
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Credential | LCSW
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Telephone | 574-406-0190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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