Provider Demographics
NPI:1649093329
Name:SHAN T GUILLORY COUNSELING GROUP
Entity type:Organization
Organization Name:SHAN T GUILLORY COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUILLORY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-557-2553
Mailing Address - Street 1:6265 E WINDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77713-1207
Mailing Address - Country:US
Mailing Address - Phone:682-557-2553
Mailing Address - Fax:
Practice Address - Street 1:3455 SARAH ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-2906
Practice Address - Country:US
Practice Address - Phone:682-557-2553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty