Doctor Name: | MS. MARYKAY SHEPHERD |
NPI Number: | 1134177355 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | 16204 |
Business Practice Address: | 371 County Road 4186 Quitman, TX - 757835005 |
Business Phone Number: | 9039672629 |
Business Fax Number: | 9039672629 |
Mailing Address: | 371 County Road 4186, QUITMAN |
State: | TX |
Postal Code: | 757835005 |
Phone Number: | 9039672629 |
Fax Number: | 9039672629 |
NPI Enumeration Date: | 05/04/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 16204 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |