Provider Demographics
NPI:1154542959
Name:SHEPPARD & ASSOCIATES PSYCHOLOGICAL SERVICES, INC.
Entity type:Organization
Organization Name:SHEPPARD & ASSOCIATES PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHEPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:502-893-4042
Mailing Address - Street 1:2915 FRANKFORT AVE
Mailing Address - Street 2:STE. E
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2682
Mailing Address - Country:US
Mailing Address - Phone:502-893-4042
Mailing Address - Fax:502-893-4043
Practice Address - Street 1:2915 FRANKFORT AVE
Practice Address - Street 2:STE. E
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2682
Practice Address - Country:US
Practice Address - Phone:502-893-4042
Practice Address - Fax:502-893-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1324103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0961301Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER