Provider Demographics
NPI:1699889691
Name:SHROYER, MARILYN KAY (LPC)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:KAY
Last Name:SHROYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:M
Other - Middle Name:KAY
Other - Last Name:SHROYER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:124 CALDWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1210
Mailing Address - Country:US
Mailing Address - Phone:281-424-9100
Mailing Address - Fax:
Practice Address - Street 1:1209 DECKER DR STE 201A
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4444
Practice Address - Country:US
Practice Address - Phone:281-793-2151
Practice Address - Fax:281-424-9100
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10420101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2279817OtherCIGNA BEHARIORAL HEALTH
TX1772360-01Medicaid
TX177236001Medicaid
TX84802LOtherBLUE CROSS BLUE SHIELD
TX270800OtherCOMPSYCH
TX831254000OtherMAGELLAN