Provider Demographics
NPI:1932493251
Name:SHEPARD, LISA S (MA, LLPC, NCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:MA, LLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16413 HOWARD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-5783
Mailing Address - Country:US
Mailing Address - Phone:586-260-4116
Mailing Address - Fax:
Practice Address - Street 1:11111 HALL ROAD #303
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5726
Practice Address - Country:US
Practice Address - Phone:773-656-6248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1800340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional