Provider Demographics
NPI:1780616771
Name:SHEPPARD, WILLIAM ROBERT SR (MAMFC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:SHEPPARD
Suffix:SR
Gender:M
Credentials:MAMFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 SW JOHNSON AVE # 2828
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-4776
Mailing Address - Country:US
Mailing Address - Phone:817-744-8734
Mailing Address - Fax:682-250-5995
Practice Address - Street 1:232 SW JOHNSON AVE # 2828
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-4776
Practice Address - Country:US
Practice Address - Phone:817-744-8734
Practice Address - Fax:682-250-5995
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3469106H00000X
TX11769101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095616102Medicaid