Provider Demographics
NPI:1033818463
Name:SHEPHERD, ANGEL (BS MATS)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:BS MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 SW A ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-3845
Mailing Address - Country:US
Mailing Address - Phone:765-962-8843
Mailing Address - Fax:
Practice Address - Street 1:1822 SW A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3845
Practice Address - Country:US
Practice Address - Phone:765-962-8843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health