Healthcare Provider Details

I. General information

NPI: 1083707947
Provider Name (Legal Business Name): JOYCE FOREMAN SHAYLER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date: 07/28/2008
Reactivation Date: 04/06/2009

III. Provider practice location address

5620 OLD BULLARD RD SUITE 111
TYLER TX
75703-4358
US

IV. Provider business mailing address

PO BOX 9684
TYLER TX
75711-2684
US

V. Phone/Fax

Practice location:
  • Phone: 903-526-7284
  • Fax: 903-534-4987
Mailing address:
  • Phone: 903-526-7284
  • Fax: 903-534-4987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13460
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number02775
License Number StateTX

VIII. Authorized Official

Name: JOYCE FOREMAN SHAYLER
Title or Position: OWNER
Credential: LCSW
Phone: 903-526-7284