MEDICARE: SHELBY RYAN URRUTIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	82077	TX

General Provider Information

NPI Number	:	1417541343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELBY RYAN URRUTIA

Provider Business Mailing Address
First Line	:	3601 S HAMPTON CT
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-3328
Country	:	US
Telephone Number	:	979-324-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S HAMPTON CT
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77801-3328
Country	:	US
Telephone Number	:	979-324-8999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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Directions to “ SHELBY RYAN URRUTIA ” Practice Location

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