Healthcare Provider Details

I. General information

NPI: 1376023341
Provider Name (Legal Business Name): SHELLEY J GUESS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 RIVERSIDE DR BLDG 6
IRVING TX
75039-4316
US

IV. Provider business mailing address

668 LAKE CAROLYN PKWY APT 206E
IRVING TX
75039-3956
US

V. Phone/Fax

Practice location:
  • Phone: 510-858-6775
  • Fax: 256-701-6926
Mailing address:
  • Phone: 817-354-5200
  • Fax: 256-701-6926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number75609
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: