Provider Demographics
NPI:1962179218
Name:SHEPHERD, EUGENE D JR
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:D
Last Name:SHEPHERD
Suffix:JR
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 1:3252 PAYDAY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-7429
Mailing Address - Country:US
Mailing Address - Phone:614-834-7922
Mailing Address - Fax:614-987-5167
Practice Address - Street 1:6161 BUSCH BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2587
Practice Address - Country:US
Practice Address - Phone:614-987-5003
Practice Address - Fax:614-987-5167
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist