Provider Demographics
NPI:1174203608
Name:SHEPHERD, BAILEY BROWN (MA)
Entity type:Individual
Prefix:MRS
First Name:BAILEY
Middle Name:BROWN
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:HARLETON
Mailing Address - State:TX
Mailing Address - Zip Code:75651-5619
Mailing Address - Country:US
Mailing Address - Phone:903-930-2170
Mailing Address - Fax:
Practice Address - Street 1:510 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:HARLETON
Practice Address - State:TX
Practice Address - Zip Code:75651-5619
Practice Address - Country:US
Practice Address - Phone:903-930-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX85065101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional