Provider Demographics
NPI:1518094127
Name:SHEPHERD, KAYE FRANCES (LCDC)
Entity Type:Individual
Prefix:MS
First Name:KAYE
Middle Name:FRANCES
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-4905
Mailing Address - Country:US
Mailing Address - Phone:409-658-7156
Mailing Address - Fax:409-983-4761
Practice Address - Street 1:3747 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-5555
Practice Address - Country:US
Practice Address - Phone:409-983-7668
Practice Address - Fax:409-983-4761
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6823101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6823OtherLIC. CHEM DEP. COUNSELOR