Provider Demographics
NPI:1750464616
Name:GRUEN, SHIRLEY N (PH D)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:N
Last Name:GRUEN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25227 SHADOWMERE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-6491
Mailing Address - Country:US
Mailing Address - Phone:281-491-5250
Mailing Address - Fax:281-242-0707
Practice Address - Street 1:101 SOUTHWESTERN BLVD
Practice Address - Street 2:#109
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3668
Practice Address - Country:US
Practice Address - Phone:281-491-5250
Practice Address - Fax:281-242-0707
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21926103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0986101-01Medicaid
TX00GK85Medicare ID - Type UnspecifiedPERSONAL MEDICARE NUMBER