Provider Demographics
NPI:1023205978
Name:SHEPARD, MELISSA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 E 120TH ST
Mailing Address - Street 2:TRAILER 6
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-3051
Mailing Address - Country:US
Mailing Address - Phone:310-668-8311
Mailing Address - Fax:
Practice Address - Street 1:1721 E 120TH ST
Practice Address - Street 2:TRAILER 6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3051
Practice Address - Country:US
Practice Address - Phone:310-668-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health