Provider Demographics
NPI:1508563065
Name:SHEPPARD, JOHN P (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 85TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-4769
Mailing Address - Country:US
Mailing Address - Phone:806-470-4947
Mailing Address - Fax:
Practice Address - Street 1:6802 ELKHART AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-1433
Practice Address - Country:US
Practice Address - Phone:806-470-4947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-03-21
Deactivation Date:2023-03-09
Deactivation Code:
Reactivation Date:2023-03-21
Provider Licenses
StateLicense IDTaxonomies
TX78399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional