MEDICARE: MRS. LISA SHEPHERD LCPC

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	101YM0800X	Mental Health Counselor	BBH-LCPC-58291	MT
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1932887429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA SHEPHERD LCPC

Provider Business Mailing Address
First Line	:	320 PUEBLO DRIVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6329
Country	:	US
Telephone Number	:	406-876-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 BROADWATER AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2813
Country	:	US
Telephone Number	:	406-250-9744
Fax Number	:

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

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	05/24/2024

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