Provider Demographics
NPI:1487102745
Name:SHEPHERD PIERCY CLARK, JILL MARIE (LMFT #106007)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:MARIE
Last Name:SHEPHERD PIERCY CLARK
Suffix:
Gender:F
Credentials:LMFT #106007
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 VICTOR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4856
Mailing Address - Country:US
Mailing Address - Phone:530-338-0087
Mailing Address - Fax:530-745-6053
Practice Address - Street 1:1465 VICTOR AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003
Practice Address - Country:US
Practice Address - Phone:530-338-0087
Practice Address - Fax:530-745-6053
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82913103TC1900X, 103TC0700X, 106H00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist