Provider Demographics
NPI:1932887429
Name:SHEPHERD, LISA (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:DAUENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 PUEBLO DRIVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6329
Mailing Address - Country:US
Mailing Address - Phone:406-876-9115
Mailing Address - Fax:
Practice Address - Street 1:415 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2813
Practice Address - Country:US
Practice Address - Phone:406-250-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-58291101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health