1699889691 NPI number — MARILYN KAY SHROYER LPC

Table of content: MARILYN KAY SHROYER LPC (NPI 1699889691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699889691 NPI number — MARILYN KAY SHROYER LPC

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHROYER
Provider Other First Name:
M
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1699889691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2024
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:
1209 DECKER DR STE 201A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAYTOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77520-4444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-793-2151
Provider Business Practice Location Address Fax Number:
281-424-9100
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: 2279817 . This is a "CIGNA BEHARIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1772360-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177236001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84802L . This is a "BLUE CROSS BLUE SHIELD" 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: 831254000 . This is a "MAGELLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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