Provider Demographics
NPI:1356495287
Name:SHEPPARD, KIRK (LMHC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 8TH AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-1452
Mailing Address - Country:US
Mailing Address - Phone:513-536-8353
Mailing Address - Fax:
Practice Address - Street 1:8118 CORPORATE WAY STE 175
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7504
Practice Address - Country:US
Practice Address - Phone:513-536-8353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001804A101YM0800X
OHE.0700338-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492477OtherBLUE SHIELD