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General NPI Number Information
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NPI Number | 1770594624
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Entity Type | Individual
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Provider Name | MARIE DENISE GUILLORY M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 6026 85TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-6709
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Country | US
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Telephone | 806-939-5673
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Fax | 806-798-0823
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Provider Business Mailing Address
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Address Line | 6026 85TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-6709
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Country | US
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Telephone | 806-939-5673
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Fax | 806-798-0823
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13891
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10521
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License Number State | OK
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