Provider Demographics
NPI:1508051053
Name:SHEPPARD, JULIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JULIA
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LCSW
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 174
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0174
Mailing Address - Country:US
Mailing Address - Phone:580-649-1100
Mailing Address - Fax:
Practice Address - Street 1:3203 S HIGHWAY 183 LOT 23
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9602
Practice Address - Country:US
Practice Address - Phone:580-649-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK12194777OtherCAQH
OK2376OtherLCSW
OK33781OtherCERTIFIED REHABILITATION COUNSELOR