Provider Demographics
NPI:1114220001
Name:SHEPHERDSON, ELAINE KAY (LMHC)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:KAY
Last Name:SHEPHERDSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10502 SATELLITE BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-8479
Mailing Address - Country:US
Mailing Address - Phone:407-850-9141
Mailing Address - Fax:
Practice Address - Street 1:10502 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-8479
Practice Address - Country:US
Practice Address - Phone:407-850-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health