Provider Demographics
NPI:1962872739
Name:SHEPHERD, KEVIN (LCSW)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 E AMBER LN
Mailing Address - Street 2:APARTMENT 206
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-6971
Mailing Address - Country:US
Mailing Address - Phone:217-474-2928
Mailing Address - Fax:
Practice Address - Street 1:2012 E AMBER LN
Practice Address - Street 2:APARTMENT 206
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-6971
Practice Address - Country:US
Practice Address - Phone:217-474-2928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0177081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical