Provider Demographics
NPI:1144797721
Name:SHEPPARD, MYRA LYNN (MASTERS DEGREE)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:LYNN
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:LYNN
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1018 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4709
Mailing Address - Country:US
Mailing Address - Phone:661-861-9967
Mailing Address - Fax:
Practice Address - Street 1:1018 21ST ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4709
Practice Address - Country:US
Practice Address - Phone:661-748-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAR8751101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YA0400XOtherBEHAVIOR HEALTH AND SO CIAL SERVICES PROVIDERS