Provider Demographics
NPI:1982113114
Name:GUILLORY, CAROLYN B (LPC, RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:B
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:LPC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8035 E R L THORNTON FWY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7018
Mailing Address - Country:US
Mailing Address - Phone:469-709-8977
Mailing Address - Fax:
Practice Address - Street 1:8035 E R L THORNTON FWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7018
Practice Address - Country:US
Practice Address - Phone:469-709-8977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX864408163WP0808X
TX71485101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health