Provider Demographics
NPI:1417266214
Name:SHEPARD, CURTIS L
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S HUALAPAI WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8834
Mailing Address - Country:US
Mailing Address - Phone:702-539-5002
Mailing Address - Fax:
Practice Address - Street 1:725 S HUALAPAI WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8834
Practice Address - Country:US
Practice Address - Phone:702-539-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker