Provider Demographics
NPI:1659330637
Name:SHEPHERD, LESLIE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:E
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W SPRING CREEK PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-4508
Mailing Address - Country:US
Mailing Address - Phone:214-618-8402
Mailing Address - Fax:870-772-4650
Practice Address - Street 1:2222 W SPRING CREEK PKWY STE 116
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-4508
Practice Address - Country:US
Practice Address - Phone:870-703-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX397321041C0700X
AR2081-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5A241Medicare PIN