Provider Demographics
NPI:1942538640
Name:SHEPHERD, JAMES G JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:SHEPHERD
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24800 CHRISANTA DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4833
Mailing Address - Country:US
Mailing Address - Phone:949-462-9114
Mailing Address - Fax:
Practice Address - Street 1:24800 CHRISANTA DR
Practice Address - Street 2:SUITE 260
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4833
Practice Address - Country:US
Practice Address - Phone:949-462-9114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23151103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical