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General NPI Number Information
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NPI Number | 1396951778
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Entity Type | Individual
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Provider Name | CYNTHIA POPELKA SHEPARD LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 12/29/2024
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Provider Practice Location Address
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Address Line | 2403 S MORAY AVE STE 3
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City | SAN PEDRO
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State | CA
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Zip | 90732-4323
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Country | US
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Telephone | 310-547-1485
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 W 25TH ST # 152
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City | SAN PEDRO
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State | CA
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Zip | 90732-4301
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Country | US
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Telephone | 310-547-1485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT24609
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License Number State | CA
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