Provider Demographics
NPI:1083977169
Name:SHEPHERD, DANIEL (DMIN, LMFT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:DMIN, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1976
Mailing Address - Country:US
Mailing Address - Phone:248-687-9251
Mailing Address - Fax:248-671-3198
Practice Address - Street 1:210 W UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1976
Practice Address - Country:US
Practice Address - Phone:248-687-9251
Practice Address - Fax:248-671-3198
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013084101YP2500X
MI4101007174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12400604OtherCAQH