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General NPI Number Information
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NPI Number | 1063637049
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Entity Type | Organization
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Legal Business Name | SHEPPERSON PSYCH ASSOC INCORPORATED
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 03/06/2009
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Provider Practice Location Address
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Address Line | 2501 E CHAPMAN AVE #200
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City | FULLERTON
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State | CA
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Zip | 92831-3132
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Country | US
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Telephone | 714-992-4240
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Fax | 714-992-5259
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Provider Business Mailing Address
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Address Line | 2501 E CHAPMAN AVE #200
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City | FULLERTON
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State | CA
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Zip | 92831-3132
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Country | US
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Telephone | 714-992-4240
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Fax | 714-992-5259
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. VANCE LEE SHEPPERSON
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Credential | PHD
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Telephone | 714-992-4240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 6775
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License Number State | CA
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