Provider Demographics
NPI:1568011559
Name:SHIRES, LAURA BETH (MA, LPC, CSC)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BETH
Last Name:SHIRES
Suffix:
Gender:F
Credentials:MA, LPC, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 NACOGDOCHES ST STE D
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3852
Mailing Address - Country:US
Mailing Address - Phone:936-262-7777
Mailing Address - Fax:
Practice Address - Street 1:114 NACOGDOCHES ST STE D
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3852
Practice Address - Country:US
Practice Address - Phone:936-262-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional