Provider Demographics
NPI:1972687796
Name:WARE-GULLY, SHIRLEY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MARIE
Last Name:WARE-GULLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 TIMBER SHADOWS DR
Mailing Address - Street 2:B
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2028
Mailing Address - Country:US
Mailing Address - Phone:281-657-6052
Mailing Address - Fax:281-657-6052
Practice Address - Street 1:2323 TIMBER SHADOWS DR
Practice Address - Street 2:B
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:281-657-6052
Practice Address - Fax:281-657-6052
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42675104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical