Doctor Name: | DR. ELISA SHEPARD |
NPI Number: | 1083081103 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | 26792 |
Business Practice Address: | 12625 La Mirada Blvd Ste 202 La Mirada, CA - 906382213 |
Business Phone Number: | 5629034800 |
Business Fax Number: | |
Mailing Address: | 12625 La Mirada Blvd Ste 202, LA MIRADA |
State: | CA |
Postal Code: | 906382213 |
Phone Number: | 5629034800 |
Fax Number: | |
NPI Enumeration Date: | 08/24/2015 |
NPI Last Update Date: | 08/24/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 26792 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |