Individual
EVAN M SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICDC, LPC
Contact information
Practice address
700 PARK AVE, IRONTON, OH 45638-1502
(740) 532-1613
(740) 879-0599
Mailing address
PO BOX 108, IRONTON, OH 45638-0108
(740) 532-1613
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LICDC.162365
OH
101YM0800X
Mental Health Counselor
C.2305222-TRNE
OH
101YP2500X
Professional Counselor
C.2406620
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0368213
—
OH
Enumeration date
04/15/2019
Last updated
11/07/2024
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