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General NPI Number Information
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NPI Number | 1053045005
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Entity Type | Organization
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Legal Business Name | BARB SHEPARD LICENSED MENTAL HEALTH COUNSELOR PLLC
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 7000 EAST GENESEE STREET BUILDING C
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City | FAYETTEVILLE
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State | NY
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Zip | 13066
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Country | US
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Telephone | 315-313-4075
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Fax |
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Provider Business Mailing Address
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Address Line | 134 HATHAWAY RD
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City | DE WITT
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State | NY
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Zip | 13214-1936
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Country | US
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Telephone | 131-548-1639
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BARBARA SHEPARD
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Credential | LMHC
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Telephone | 315-313-4075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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