Active NPI
Carlisia Shepherd
- Mental Health Counselor
- Wimauma, FL
National Provider Identifier
1417488537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 1326311085
- Practice address
- 10874 Standing Stone Dr
Wimauma, FL 33598-6161 - Phone
- (813) 356-9020
- NPI assigned
- Mar 21, 2017
- Last updated
- Mar 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 1326311085 | FL | Primary |
Addresses
Primary practice location
10874 Standing Stone Dr
Wimauma, FL 33598-6161
Mailing address
10874 Standing Stone Dr
Wimauma, FL 33598-6161
Phone (813) 356-9020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1326311085 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490054400000",
"number": "1417488537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10874 STANDING STONE DR",
"city": "WIMAUMA",
"state": "FL",
"postal_code": "335986161",
"telephone_number": "813-356-9020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10874 STANDING STONE DR",
"city": "WIMAUMA",
"state": "FL",
"postal_code": "335986161",
"telephone_number": "813-356-9020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPHERD",
"first_name": "CARLISIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-21",
"last_updated": "2017-03-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "1326311085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wimauma, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.