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General NPI Number Information
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NPI Number | 1891588174
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Entity Type | Individual
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Provider Name | PAYTON SHEPHERD
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Gender | Female
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Dates
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Enumeration Date | 05/28/2025
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Last Update Date | 05/28/2025
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Provider Practice Location Address
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Address Line | 214 N CLAY AVE STE 215
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City | KIRKWOOD
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State | MO
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Zip | 63122-4068
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Country | US
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Telephone | 314-852-0773
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Fax |
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Provider Business Mailing Address
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Address Line | 1969 HERITAGE FARMS DR
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City | PACIFIC
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State | MO
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Zip | 63069-3624
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Country | US
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Telephone | 314-852-0773
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2022029630
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License Number State | MO
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