Provider Demographics
NPI:1801091194
Name:SHEPHERD, CHRISTINE E (CMT, NCBTMB, LPC)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:CMT, NCBTMB, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MOUNTAIN SHADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9356
Mailing Address - Country:US
Mailing Address - Phone:307-752-1387
Mailing Address - Fax:307-672-8508
Practice Address - Street 1:37 N SCOTT ST STE 28
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6361
Practice Address - Country:US
Practice Address - Phone:307-752-1387
Practice Address - Fax:307-672-8508
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYNO LICENSING BOARD225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000 390286-00OtherNCBTMB
83778OtherAMTA