Provider Demographics
NPI:1194981704
Name:SHEPARD, TAMMY SHARIE (LPC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SHARIE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-1316
Mailing Address - Country:US
Mailing Address - Phone:573-559-2380
Mailing Address - Fax:
Practice Address - Street 1:875 ST. HWY VV
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63822-6382
Practice Address - Country:US
Practice Address - Phone:573-888-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-03
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008023010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional