Derrick Eugene Shepherd
Individual provider Active NPI Mental Health Counselor · Richvale, CA
NPI 1639711310 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1639711310
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 1229 Broadway St
Richvale, CA 95974 - Phone
- (530) 882-4125
- Fax
- (530) 894-5791
- NPI assigned
- Oct 14, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Youth for Change | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
1229 Broadway St
Richvale, CA 95974
Mailing address
350 Main St
Quincy, CA 95971
Phone (530) 283-3330
Other providers in Richvale, CA
- Jared Shawn Dubose
- Environmental Alternatives
- Rosemary Henman
- Joseph Ezra Ilaoa
- Shari Lee Mota
- Arthur Wylie
- Arthur Joe Wylie IV
- Eden Wylie
All providers in Richvale, CA · Mental Health Counselor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.