Healthcare Provider Details

I. General information

NPI: 1073349221
Provider Name (Legal Business Name): SHAYLEE GUTIERREZ LPC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S MADISON ST
MCGREGOR TX
76657-2328
US

IV. Provider business mailing address

PO BOX 24077
WACO TX
76702-4077
US

V. Phone/Fax

Practice location:
  • Phone: 254-236-4158
  • Fax: 254-613-5076
Mailing address:
  • Phone: 254-236-4158
  • Fax: 254-613-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAYLEE GUTIERREZ
Title or Position: OWNER
Credential: LPC
Phone: 254-236-4158