Provider Demographics
NPI:1083707947
Name:JOYCE FOREMAN SHAYLER
Entity type:Organization
Organization Name:JOYCE FOREMAN SHAYLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:FOREMAN
Authorized Official - Last Name:SHAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-526-7284
Mailing Address - Street 1:PO BOX 9684
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-2684
Mailing Address - Country:US
Mailing Address - Phone:903-526-7284
Mailing Address - Fax:903-534-4987
Practice Address - Street 1:5620 OLD BULLARD RD
Practice Address - Street 2:SUITE 111
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4358
Practice Address - Country:US
Practice Address - Phone:903-526-7284
Practice Address - Fax:903-534-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-04-06
Deactivation Date:2008-07-28
Deactivation Code:
Reactivation Date:2009-04-06
Provider Licenses
StateLicense IDTaxonomies
TX13460101YP2500X
TX02775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00846YMedicare ID - Type UnspecifiedGROUP NUMBER