Provider Demographics
NPI:1104837061
Name:SHEPHERD, MARY ANN (PHD, BCBA-D, HSP)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PHD, BCBA-D, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 COMMONS CIR STE B
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-9538
Mailing Address - Country:US
Mailing Address - Phone:405-467-6782
Mailing Address - Fax:405-467-6100
Practice Address - Street 1:1817 COMMONS CIR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-9505
Practice Address - Country:US
Practice Address - Phone:405-467-6105
Practice Address - Fax:405-467-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-14-15110103K00000X
OK44454103TS0200X
OK1231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool