Provider Demographics
NPI:1063637049
Name:SHEPPERSON PSYCH ASSOC INCORPORATED
Entity type:Organization
Organization Name:SHEPPERSON PSYCH ASSOC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHEPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-992-4240
Mailing Address - Street 1:2501 E CHAPMAN AVE
Mailing Address - Street 2:#200
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3132
Mailing Address - Country:US
Mailing Address - Phone:714-992-4240
Mailing Address - Fax:714-992-5259
Practice Address - Street 1:2501 E CHAPMAN AVE
Practice Address - Street 2:#200
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3132
Practice Address - Country:US
Practice Address - Phone:714-992-4240
Practice Address - Fax:714-992-5259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty