Provider Demographics
NPI:1356917645
Name:GOLDSTEIN, SHELLEY (LPC)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:GOLDSTEIN
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 1:11514 OAK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4639
Mailing Address - Country:US
Mailing Address - Phone:512-230-3775
Mailing Address - Fax:
Practice Address - Street 1:11514 OAK VIEW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4639
Practice Address - Country:US
Practice Address - Phone:512-230-3775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76692101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor