Elisa Shepard, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

26792 Issued in CA

Practice address

12625 La Mirada Blvd Ste 202
La Mirada, CA 90638-2213

Phone

(562) 903-4800

NPI assigned

Aug 24, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2015 through Oct 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Biola Counseling Center

  • Clinical Psychologist
  • La Mirada, CA
  • NPI 1255547378
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440374400000",
    "number": "1083081103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 LA MIRADA BLVD STE 202",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906382213",
            "telephone_number": "562-903-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 LA MIRADA BLVD STE 202",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906382213",
            "telephone_number": "562-903-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHEPARD",
        "first_name": "ELISA",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-24",
        "last_updated": "2015-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "26792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Santos, RDHAP
• Camilla S Seippel, PSY.D.
• Sergio Ocampo DDS PC
• Aditi J Shah, RD
• Ajit Chunilal Shah, M.D.
• Shepherd'S Hope Home Health Services, Inc.
• Lyncie Elizabeth Raju Shiau, NP
• Shield Transportation Services
• Dongsoo Shin, M.D
• Kwangsun Chun Shin

• Clinical Psychologist in La Mirada, CA
• Providers in La Mirada, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.