Provider Demographics
NPI:1912492737
Name:SHEPHERD, RODNEY (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 SEABROOK DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4538
Mailing Address - Country:US
Mailing Address - Phone:214-335-4840
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD STE 100-F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6190
Practice Address - Country:US
Practice Address - Phone:817-989-6332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76085101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty