Provider Demographics
NPI:1699819748
Name:SHEPPARD, REGAN A (LMFT)
Entity type:Individual
Prefix:MRS
First Name:REGAN
Middle Name:A
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 E JACKSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6773
Mailing Address - Country:US
Mailing Address - Phone:541-526-1953
Mailing Address - Fax:
Practice Address - Street 1:810 E JACKSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6773
Practice Address - Country:US
Practice Address - Phone:360-224-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
ORT0776106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00053311OtherREGISTERED COUNSELOR