Provider Demographics
NPI:1801924071
Name:SHAPARD, KATHRYNE S (MA)
Entity type:Individual
Prefix:MS
First Name:KATHRYNE
Middle Name:S
Last Name:SHAPARD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:KITTY
Other - Middle Name:
Other - Last Name:SHAPARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:1803 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-2201
Mailing Address - Country:US
Mailing Address - Phone:931-461-1315
Mailing Address - Fax:
Practice Address - Street 1:1803 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2201
Practice Address - Country:US
Practice Address - Phone:931-461-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE 0000001276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health