Provider Demographics
NPI:1710053202
Name:SHEPARD, DARREN EDWARD (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:EDWARD
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 FREEBOARD DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:W SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5039
Mailing Address - Country:US
Mailing Address - Phone:530-351-7975
Mailing Address - Fax:
Practice Address - Street 1:3120 FREEBOARD DR
Practice Address - Street 2:STE. 102
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-5039
Practice Address - Country:US
Practice Address - Phone:530-351-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82009106H00000X
CAIMF 58750106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist