Provider Demographics
NPI:1508023474
Name:SHIRLEY N GRUEN PH D P C
Entity Type:Organization
Organization Name:SHIRLEY N GRUEN PH D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRUEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-491-5250
Mailing Address - Street 1:25227 SHADOWMERE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6491
Mailing Address - Country:US
Mailing Address - Phone:281-491-5250
Mailing Address - Fax:281-242-0707
Practice Address - Street 1:101 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 109
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3548
Practice Address - Country:US
Practice Address - Phone:281-491-5250
Practice Address - Fax:281-242-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21926261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0986101-01Medicaid
TX0986101-01Medicaid