Provider Demographics
NPI:1073349221
Name:SHAYLEE GUTIERREZ LPC PLLC
Entity type:Organization
Organization Name:SHAYLEE GUTIERREZ LPC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-236-4158
Mailing Address - Street 1:PO BOX 24077
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-4077
Mailing Address - Country:US
Mailing Address - Phone:254-236-4158
Mailing Address - Fax:254-613-5076
Practice Address - Street 1:213 S MADISON ST
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-2328
Practice Address - Country:US
Practice Address - Phone:254-236-4158
Practice Address - Fax:254-613-5076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty