Individual
ETHAN CHRISTOPHER SHEPHERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1907 11TH ST, PORTSMOUTH, OH 45662-4531
(513) 941-4999
(513) 694-0168
Mailing address
6460 HARRISON AVE STE 200, CINCINNATI, OH 45247-7821
(513) 941-4999
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA.179916
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CDCA.184392
OH
101YM0800X
Mental Health Counselor
APS.003292
OH
101YM0800X
Mental Health Counselor
QMHS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0483357
—
OH
Enumeration date
04/19/2022
Last updated
03/16/2026
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