Provider Demographics
NPI:1376023341
Name:GUESS, SHELLEY J (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:GUESS
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 1:668 LAKE CAROLYN PKWY APT 206E
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3956
Mailing Address - Country:US
Mailing Address - Phone:817-354-5200
Mailing Address - Fax:256-701-6926
Practice Address - Street 1:5000 RIVERSIDE DR BLDG 6
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4316
Practice Address - Country:US
Practice Address - Phone:510-858-6775
Practice Address - Fax:256-701-6926
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-18
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 101YM0800X
TX75609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty