Provider Demographics
NPI:1134679822
Name:SHEPLER, TRACY L (PSYD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:L
Last Name:SHEPLER
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 VALLECITOS DE ORO STE A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1423
Mailing Address - Country:US
Mailing Address - Phone:252-723-1918
Mailing Address - Fax:
Practice Address - Street 1:125 VALLECITOS DE ORO STE A
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1423
Practice Address - Country:US
Practice Address - Phone:252-723-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-17972103K00000X
CAPSY30163103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst