Provider Demographics
NPI:1649306630
Name:RAMOS-AYALA, SHAMIRA JANELLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHAMIRA
Middle Name:JANELLE
Last Name:RAMOS-AYALA
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 1:195 MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1270
Mailing Address - Country:US
Mailing Address - Phone:817-706-3574
Mailing Address - Fax:
Practice Address - Street 1:1616 MISTLETOE BLVD APT 100
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4047
Practice Address - Country:US
Practice Address - Phone:817-706-3574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62810101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX316530002Medicaid