Provider Demographics
NPI:1346760527
Name:SHEPHERD, MORGAN RICHARD (MFTI)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:RICHARD
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 KEY ROUTE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1717
Mailing Address - Country:US
Mailing Address - Phone:208-867-3909
Mailing Address - Fax:
Practice Address - Street 1:3727 SUNSET LN
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6134
Practice Address - Country:US
Practice Address - Phone:925-778-1667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF73942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist