1699933184 NPI number — MARILYN K SHROYER MS LPC COUNSELING

Table of content: (NPI 1699933184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699933184 NPI number — MARILYN K SHROYER MS LPC COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARILYN K SHROYER MS LPC COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARILYN KAY SHROYER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699933184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 CALDWELL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77520-1210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-424-9100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2802 GARTH RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77521-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-427-5208
Provider Business Practice Location Address Fax Number:
281-428-0937
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHROYER
Authorized Official First Name:
MARILYN
Authorized Official Middle Name:
KAY
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
281-427-5208

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  10420 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84802L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 177236001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 831254000 . This is a "MAGELLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 270800 . This is a "COMPSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2279817 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com