Provider Demographics
NPI:1851991905
Name:SHIRLEY, JASON ALAN (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:686 COUNTY ROAD 593
Mailing Address - Street 2:
Mailing Address - City:KIRBYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75956-3255
Mailing Address - Country:US
Mailing Address - Phone:409-594-5075
Mailing Address - Fax:
Practice Address - Street 1:686 COUNTY ROAD 593
Practice Address - Street 2:
Practice Address - City:KIRBYVILLE
Practice Address - State:TX
Practice Address - Zip Code:75956-3255
Practice Address - Country:US
Practice Address - Phone:409-594-5075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75525101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional