MEDICARE: SHIRLEY JEAN RICHEY M.A., L.P.C., N.C.C.

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	101YP2500X	Professional Counselor	69993	TX

General Provider Information

NPI Number	:	1487917902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY JEAN RICHEY M.A., L.P.C., N.C.C.

Provider Business Mailing Address
First Line	:	PO BOX 3036
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77903-3036
Country	:	US
Telephone Number	:	361-571-1844
Fax Number	:

Provider Business Practice Location Address
First Line	:	5606 N NAVARRO ST
Second Line	:	SUITE 109
City	:	VICTORIA
State	:	TX
Zip	:	77904-1727
Country	:	US
Telephone Number	:	361-571-1844
Fax Number	:

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

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	11/08/2012

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