Provider Demographics
NPI:1619031176
Name:SHEPHERD, VICTORIA SUZANNE (LPC, LADC)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:SUZANNE
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LPC, LADC
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 579
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74502-0579
Mailing Address - Country:US
Mailing Address - Phone:918-426-7844
Mailing Address - Fax:918-426-5526
Practice Address - Street 1:1101 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4815
Practice Address - Country:US
Practice Address - Phone:918-426-7844
Practice Address - Fax:918-426-5526
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK454101YA0400X
OK2342101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)