Provider Demographics
NPI:1356495287
Name:SHEPPARD, KIRK (LMHC)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 6019
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4124
Mailing Address - Fax:513-636-4283
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 6019
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4124
Practice Address - Fax:513-636-4283
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001804A101YM0800X
OHE.0700338-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000492477OtherBLUE SHIELD