Provider Demographics
NPI:1972848109
Name:GUIDRY, KELLY SUE (LPC-S, LSOTP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:LPC-S, LSOTP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:SUE
Other - Last Name:GREGGERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25511 BUDDE RD STE 1303
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2092
Mailing Address - Country:US
Mailing Address - Phone:281-210-6677
Mailing Address - Fax:
Practice Address - Street 1:25511 BUDDE RD STE 1303
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2092
Practice Address - Country:US
Practice Address - Phone:281-210-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional