Provider Demographics
NPI:1689799496
Name:SEWELL, SHIRLEY MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:MARIE
Last Name:SEWELL
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 1:2228 WATERFORD VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1840
Mailing Address - Country:US
Mailing Address - Phone:281-831-6828
Mailing Address - Fax:281-403-1480
Practice Address - Street 1:4915 S MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4601
Practice Address - Country:US
Practice Address - Phone:281-831-6828
Practice Address - Fax:281-403-1480
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional