Provider Demographics
NPI:1548360506
Name:SHAMI, GLORIA KEMP (LPC LMFT AAC)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:KEMP
Last Name:SHAMI
Suffix:
Gender:F
Credentials:LPC LMFT AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 W PIPELINE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053
Mailing Address - Country:US
Mailing Address - Phone:817-282-6236
Mailing Address - Fax:817-285-9542
Practice Address - Street 1:1050 W PIPELINE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-282-6236
Practice Address - Fax:817-285-9542
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC09632101Y00000X
TXAAC16931100101YA0400X
TXLMFT000296042264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128544OtherMHN
TX025762801Medicaid
TX025762801Medicaid