Provider Demographics
NPI:1790910842
Name:SHEPARD, LISA M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 STEWARTSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2947
Mailing Address - Country:US
Mailing Address - Phone:304-284-8438
Mailing Address - Fax:
Practice Address - Street 1:1553 STEWARTSTOWN RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2947
Practice Address - Country:US
Practice Address - Phone:304-284-8438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional