Provider Demographics
NPI:1710905591
Name:SHEPPARD, JULIE MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:MICHELLE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:MICHELLE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2720 PARK PL
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-6324
Mailing Address - Country:US
Mailing Address - Phone:817-810-0030
Mailing Address - Fax:817-293-0382
Practice Address - Street 1:2720 PARK PL
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-6324
Practice Address - Country:US
Practice Address - Phone:817-675-7087
Practice Address - Fax:817-877-3562
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063894201Medicaid