Provider Demographics
NPI:1730439449
Name:M S SHEPARD PSYD LLC
Entity type:Organization
Organization Name:M S SHEPARD PSYD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/ BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-776-7732
Mailing Address - Street 1:2775 S JONES BLVD
Mailing Address - Street 2:101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5631
Mailing Address - Country:US
Mailing Address - Phone:702-326-5390
Mailing Address - Fax:702-586-3333
Practice Address - Street 1:2775 S JONES BLVD
Practice Address - Street 2:101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5631
Practice Address - Country:US
Practice Address - Phone:702-326-5390
Practice Address - Fax:702-586-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPY 0540OtherLICENSE