Provider Demographics
NPI:1477577641
Name:SHEPHERD, JUNE ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:ELLEN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 CALHOUN ST.
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:512-789-5906
Mailing Address - Fax:
Practice Address - Street 1:MENTAL HEALTH CLINIC, 27 TH SPECIAL OPERATIONS GROUP
Practice Address - Street 2:208 CASABLANCA
Practice Address - City:CANNON AFB
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:575-784-1108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036088501Medicaid
TX036088501Medicaid