Provider Demographics
NPI:1316372469
Name:FLORES, SALLY SPEER (LPC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:SPEER
Last Name:FLORES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 TARLETON ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-5113
Mailing Address - Country:US
Mailing Address - Phone:432-570-1084
Mailing Address - Fax:432-570-1084
Practice Address - Street 1:1004 N BIG SPRING ST
Practice Address - Street 2:SUITE 325
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3354
Practice Address - Country:US
Practice Address - Phone:432-570-1084
Practice Address - Fax:432-570-4069
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional