Provider Demographics
NPI:1457961997
Name:FYFFE-PARKER, SHELLEAN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEAN
Middle Name:
Last Name:FYFFE-PARKER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 NEWPORT LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1614
Mailing Address - Country:US
Mailing Address - Phone:713-941-9903
Mailing Address - Fax:
Practice Address - Street 1:2630 NEWPORT LAKE BLVD
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1614
Practice Address - Country:US
Practice Address - Phone:713-941-9903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional