Provider Demographics
NPI:1386850907
Name:SHEPARD, SHARON BARBARA (MFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:BARBARA
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-0763
Mailing Address - Country:US
Mailing Address - Phone:530-842-7227
Mailing Address - Fax:530-459-5400
Practice Address - Street 1:208 4TH ST
Practice Address - Street 2:208 4TH STREET
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-2911
Practice Address - Country:US
Practice Address - Phone:530-841-4832
Practice Address - Fax:530-841-4299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 25161106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist