Provider Demographics
NPI:1639711310
Name:SHEPHERD, DERRICK EUGENE
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:EUGENE
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971
Mailing Address - Country:US
Mailing Address - Phone:530-283-3330
Mailing Address - Fax:530-283-2150
Practice Address - Street 1:1229 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:RICHVALE
Practice Address - State:CA
Practice Address - Zip Code:95974
Practice Address - Country:US
Practice Address - Phone:530-882-4125
Practice Address - Fax:530-894-5791
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health