Provider Demographics
NPI:1497111926
Name:SHEPHERD, RACHELLE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LMSW
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 471193
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74147-1193
Mailing Address - Country:US
Mailing Address - Phone:360-631-2702
Mailing Address - Fax:
Practice Address - Street 1:4336 S 109TH EAST AVE
Practice Address - Street 2:#906
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5316
Practice Address - Country:US
Practice Address - Phone:360-631-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker