Provider Demographics
NPI:1003979956
Name:SHEPHERD, JOANN (MA, CDP, LMHC)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA, CDP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:9706 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2157
Practice Address - Country:US
Practice Address - Phone:206-302-2900
Practice Address - Fax:206-302-2910
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002245101YA0400X
WALH00005465101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP00002245OtherCHEMICAL DEPENDANCY PROF