Provider Demographics
NPI:1588445167
Name:SHEPHERD, BRIAN KEITH
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 ARMADILLO RUN
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452-5439
Mailing Address - Country:US
Mailing Address - Phone:850-398-2086
Mailing Address - Fax:
Practice Address - Street 1:6400 PRESS DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126-1009
Practice Address - Country:US
Practice Address - Phone:504-286-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)