Provider Demographics
NPI:1073738746
Name:SPIKE SHEPHERD, MINDI SUE
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:SUE
Last Name:SPIKE SHEPHERD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 HARRISON ST
Mailing Address - Street 2:#3
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5452
Mailing Address - Country:US
Mailing Address - Phone:415-690-5234
Mailing Address - Fax:
Practice Address - Street 1:2245 BACON ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2021
Practice Address - Country:US
Practice Address - Phone:925-827-3857
Practice Address - Fax:925-827-4104
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor