Individual
MRS. CLARISSA JANE SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4720 RIVER RD N, KEIZER, OR 97303-4536
(503) 580-1024
Mailing address
4720 RIVER RD N, KEIZER, OR 97303-4536
(503) 580-1024
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C1781
OR
101YP1600X
Pastoral Counselor
C1781
OR
101YP2500X
Professional Counselor
C1781
OR
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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