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General NPI Number Information
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NPI Number | 1891277125
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Entity Type | Individual
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Provider Name | NICOLE ROSE SHEPHERD M.A, LPC-MHSP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 1415 OLD WEISGARBER RD STE 360
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City | KNOXVILLE
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State | TN
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Zip | 37909-1381
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Country | US
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Telephone | 865-588-3173
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Fax | 865-588-3174
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Provider Business Mailing Address
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Address Line | 1415 OLD WEISGARBER RD STE 360
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City | KNOXVILLE
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State | TN
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Zip | 37909-1381
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Country | US
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Telephone | 865-588-3173
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Fax | 865-588-3174
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4192
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License Number State | TN
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