Provider Demographics
NPI:1497905848
Name:CLARY-ANTHONY, SHIRLEY (LPC-S)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:CLARY-ANTHONY
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:TX
Mailing Address - Zip Code:76623-0090
Mailing Address - Country:US
Mailing Address - Phone:214-212-3274
Mailing Address - Fax:972-627-3234
Practice Address - Street 1:115 OLD BLOOMING GROVE RD
Practice Address - Street 2:
Practice Address - City:ITALY
Practice Address - State:TX
Practice Address - Zip Code:76651
Practice Address - Country:US
Practice Address - Phone:214-212-3274
Practice Address - Fax:972-627-3234
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17913101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health