Doctor Name: | TARA LEE SHEPHERD |
NPI Number: | 1023327715 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, CAS |
License Number: | 03-079940 |
Business Practice Address: | 441 N Main St Alturas, CA - 961013457 |
Business Phone Number: | 5302336312 |
Business Fax Number: | 5302336339 |
Mailing Address: | 441 N Main St, ALTURAS |
State: | CA |
Postal Code: | 961013457 |
Phone Number: | 5302336312 |
Fax Number: | 5302336339 |
NPI Enumeration Date: | 09/29/2010 |
NPI Last Update Date: | 09/29/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 03-079940 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |