Provider Demographics
NPI:1487526471
Name:PATEL, SHRUTI VIMAL (LPC-A)
Entity type:Individual
Prefix:
First Name:SHRUTI
Middle Name:VIMAL
Last Name:PATEL
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4845
Mailing Address - Country:US
Mailing Address - Phone:347-685-6758
Mailing Address - Fax:
Practice Address - Street 1:2280 HIGHLAND VILLAGE RD STE 150
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7184
Practice Address - Country:US
Practice Address - Phone:972-498-1307
Practice Address - Fax:972-435-4483
Is Sole Proprietor?:No
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional