Provider Demographics
NPI:1487294120
Name:SHEPHARD, STEVEN EUGENE (LPC , MED, MS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EUGENE
Last Name:SHEPHARD
Suffix:
Gender:M
Credentials:LPC , MED, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 BOALSBURG PIKE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1133
Mailing Address - Country:US
Mailing Address - Phone:814-777-7461
Mailing Address - Fax:
Practice Address - Street 1:103 E BEAVER AVE STE 2
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4969
Practice Address - Country:US
Practice Address - Phone:814-409-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty