Individual
TARA KAY SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13001 23 MILE RD STE 103, SHELBY TOWNSHIP, MI 48315-2767
(586) 496-4398
Mailing address
18119 RED OAKS DR, MACOMB, MI 48044-2776
(734) 748-4826
(800) 248-1568
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6361005957
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
382230613
FIN #
MI
Enumeration date
08/31/2011
Last updated
04/05/2022
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