MEDICARE: SHIRLEY MARIE WARE-GULLY LCSW

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	104100000X	Social Worker	42675	TX
2	1041C0700X	Clinical Social Worker	42675	TX

General Provider Information

NPI Number	:	1972687796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY MARIE WARE-GULLY LCSW

Provider Business Mailing Address
First Line	:	2323 TIMBER SHADOWS DR
Second Line	:	B
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2028
Country	:	US
Telephone Number	:	281-657-6052
Fax Number	:	281-657-6052

Provider Business Practice Location Address
First Line	:	2323 TIMBER SHADOWS DR
Second Line	:	B
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2028
Country	:	US
Telephone Number	:	281-657-6052
Fax Number	:	281-657-6052

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	09/11/2025

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