Provider Demographics
NPI:1831377076
Name:SHOAL CREEK COUNSELING, P.L.L.C.
Entity type:Organization
Organization Name:SHOAL CREEK COUNSELING, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC
Authorized Official - Phone:512-619-4966
Mailing Address - Street 1:8307 SHOAL CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7525
Mailing Address - Country:US
Mailing Address - Phone:512-619-4966
Mailing Address - Fax:512-451-0090
Practice Address - Street 1:8307 SHOAL CREEK BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7525
Practice Address - Country:US
Practice Address - Phone:512-619-4966
Practice Address - Fax:512-451-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14192101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty