# KASEY SHEPHERD LSCSW LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063039139
- **Authorized official:** NINA M WILLIAMS (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (316) 516-2339

## Contact information

- **Practice address:** 200 N BROADWAY AVE STE 500, WICHITA, KS 67202-2322
- **Practice address phone:** (316) 425-7774
- **Practice address fax:** (316) 425-7779
- **Mailing address:** 200 N BROADWAY AVE STE 500, WICHITA, KS 67202-2322
- **Mailing address phone:** (316) 425-7774
- **Mailing address fax:** (316) 425-7779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2020
- **Last updated:** 06/24/2024