Provider Demographics
NPI:1578581211
Name:SHEPHERD-LOOK, DEE LORIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEE
Middle Name:LORIS
Last Name:SHEPHERD-LOOK
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 1:18924 BLACKHAWK ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3333
Mailing Address - Country:US
Mailing Address - Phone:818-831-0113
Mailing Address - Fax:818-831-5755
Practice Address - Street 1:22900 VENTURA BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1204
Practice Address - Country:US
Practice Address - Phone:818-224-3320
Practice Address - Fax:818-831-5755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6505103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3293226Medicaid
CACP6505Medicare ID - Type Unspecified
CAPSY065050Medicare UPIN