ETHAN CHRISTOPHER SHEPHERD NPI 1871236687

NPI Information

NPI: 1871236687
Provider Name: ETHAN CHRISTOPHER SHEPHERD
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
1907 11TH ST
PORTSMOUTH, OH
ZIP 45662
Phone: (513) 941-4999
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Ethan Christopher Shepherd is an addiction (substance use disorder) counselor in Portsmouth, OH. Ethan Christopher Shepherd NPI is 1871236687. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1907 11TH ST
PORTSMOUTH, OH
ZIP 45662-531
Phone: (513) 941-4999
Fax: (513) 694-0168

The enumeration date for this NPI number is 4/19/2022 and was last updated on 9/29/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CDCA.179916	OHIO	No
2	101YM0800X	Counselor	Mental Health	APS.003292	OHIO	No
3	101YM0800X	Counselor	Mental Health	QMHS	OHIO	No
4	101YA0400X	Counselor	Addiction (Substance Use Disorder)	CDCA.184392	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0483357	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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