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General NPI Number Information
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NPI Number | 1073349221
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Entity Type | Organization
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Legal Business Name | SHAYLEE GUTIERREZ LPC PLLC
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 213 S MADISON ST
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City | MCGREGOR
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State | TX
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Zip | 76657-2328
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Country | US
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Telephone | 254-236-4158
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Fax | 254-613-5076
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Provider Business Mailing Address
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Address Line | PO BOX 24077
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City | WACO
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State | TX
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Zip | 76702-4077
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Country | US
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Telephone | 254-236-4158
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Fax | 254-613-5076
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Authorized Official
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Title or Position | OWNER
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Name | SHAYLEE GUTIERREZ
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Credential | LPC
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Telephone | 254-236-4158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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