Provider Demographics
NPI:1104162379
Name:SHEPLER, DUSTIN KEITH (PHD, LP, HSP, CST)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:KEITH
Last Name:SHEPLER
Suffix:
Gender:M
Credentials:PHD, LP, HSP, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 W LA SALLE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2556
Mailing Address - Country:US
Mailing Address - Phone:419-303-9542
Mailing Address - Fax:
Practice Address - Street 1:41400 DEQUINDRE RD STE 110
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-3751
Practice Address - Country:US
Practice Address - Phone:586-580-2975
Practice Address - Fax:586-580-2954
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015402103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1104162379Medicaid