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General NPI Number Information
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NPI Number | 1760729818
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Entity Type | Individual
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Provider Name | THOMASINE SHEPARD MA
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Gender | Female
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Dates
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Enumeration Date | 01/09/2013
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 3808 W RIVERSIDE DR STE 301
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City | BURBANK
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State | CA
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Zip | 91505-4325
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Country | US
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Telephone | 818-741-2899
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Fax |
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Provider Business Mailing Address
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Address Line | 11012 VENTURA BLVD STE. 78
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City | STUDIO CITY
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State | CA
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Zip | 91604-3546
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Country | US
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Telephone | 818-741-2899
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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 | 84324
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License Number State | CA
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