Basic Information
| Provider Information | |||||||||
| NPI: | 1710053202 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEPARD | ||||||||
| FirstName: | DARREN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 FREEBOARD DR | ||||||||
| Address2: | STE. 102 | ||||||||
| City: | W SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956915039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303517975 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3120 FREEBOARD DR | ||||||||
| Address2: | STE. 102 | ||||||||
| City: | W SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956915039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5303517975 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/27/2006 | ||||||||
| LastUpdateDate: | 05/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 82009 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.