Provider Demographics
NPI:1811439235
Name:SHEPHERD, BURTON HALE JR (LPC)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:HALE
Last Name:SHEPHERD
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 MCKINNEY AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3382
Mailing Address - Country:US
Mailing Address - Phone:214-438-4835
Mailing Address - Fax:
Practice Address - Street 1:5220 MCKINNEY AVE STE 202
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3382
Practice Address - Country:US
Practice Address - Phone:214-438-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional