MEDICARE: MRS. SHANTEL RAYFORD LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency		TX
2	101YP2500X	Professional Counselor	89804	TX
3	101YM0800X	Mental Health Counselor	89804	TX

General Provider Information

NPI Number	:	1447951447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHANTEL RAYFORD LPC

Provider Business Mailing Address
First Line	:	25807 WESTHEIMER PKWY STE 302
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-5342
Country	:	US
Telephone Number	:	832-862-5950
Fax Number	:	346-396-3590

Provider Business Practice Location Address
First Line	:	25807 WESTHEIMER PKWY STE 302
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-5342
Country	:	US
Telephone Number	:	832-862-5950
Fax Number	:	346-396-3590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	06/27/2024

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