Provider Demographics
NPI:1184867905
Name:SHEPHERD, LANE LEE (LPC)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:LEE
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 E SAINT GEORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3035
Mailing Address - Country:US
Mailing Address - Phone:435-673-6111
Mailing Address - Fax:800-673-0994
Practice Address - Street 1:747 E SAINT GEORGE BLVD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3035
Practice Address - Country:US
Practice Address - Phone:435-673-6111
Practice Address - Fax:800-673-0994
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4913213-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional