Provider Demographics
NPI:1538530654
Name:SHEPPARD, WILLIAM BRAD
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRAD
Last Name:SHEPPARD
Suffix:
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 1:10900 S PENNSYLVANIA AVE APT 638
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-4247
Mailing Address - Country:US
Mailing Address - Phone:405-520-4426
Mailing Address - Fax:
Practice Address - Street 1:10900 S PENNSYLVANIA AVE APT 638
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-4247
Practice Address - Country:US
Practice Address - Phone:405-520-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKD003749152101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)