Provider Demographics
NPI:1770594624
Name:GUILLORY, MARIE DENISE (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:DENISE
Last Name:GUILLORY
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 85TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-6709
Mailing Address - Country:US
Mailing Address - Phone:806-939-5673
Mailing Address - Fax:806-798-0823
Practice Address - Street 1:6026 85TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-6709
Practice Address - Country:US
Practice Address - Phone:806-939-5673
Practice Address - Fax:806-798-0823
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13891101YP2500X
OK10521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional