Provider Demographics
NPI:1265841761
Name:SHETTER, SALLY KATE (LPC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:KATE
Last Name:SHETTER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:
Other - Last Name:SHETTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1336
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2213
Mailing Address - Country:US
Mailing Address - Phone:361-777-3991
Mailing Address - Fax:361-777-0610
Practice Address - Street 1:2808 INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102
Practice Address - Country:US
Practice Address - Phone:361-358-8000
Practice Address - Fax:361-362-0695
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67667101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health