Provider Demographics
NPI:1902302003
Name:GUILLORY, SHAN T (LPC)
Entity type:Individual
Prefix:
First Name:SHAN
Middle Name:T
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9526 PALOMA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-8440
Mailing Address - Country:US
Mailing Address - Phone:682-557-2553
Mailing Address - Fax:
Practice Address - Street 1:9526 PALOMA CREEK DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-8440
Practice Address - Country:US
Practice Address - Phone:682-557-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79585101YM0800X, 101YP2500X, 101Y00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No251B00000XAgenciesCase Management