MEDICARE: NICOLE SHEPARD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701005436	VA

General Provider Information

NPI Number	:	1265873871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SHEPARD LPC

Provider Business Mailing Address
First Line	:	2 N CENTRAL AVE
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4268
Country	:	US
Telephone Number	:	540-414-1149
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 N CENTRAL AVE
Second Line	:
City	:	STAUNTON
State	:	VA
Zip	:	24401-4268
Country	:	US
Telephone Number	:	540-949-7045
Fax Number	:	540-949-8897

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	04/06/2023

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