Provider Demographics
NPI:1700365004
Name:SHEPECK, FALON RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:FALON
Middle Name:RENEE
Last Name:SHEPECK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:FALON
Other - Middle Name:
Other - Last Name:HAYGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:709 ANDERSON MILL DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49097-7764
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3317 GREENLEAF BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2516
Practice Address - Country:US
Practice Address - Phone:269-425-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017350103T00000X
MI6401222591101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional