Provider Demographics
NPI:1184212839
Name:COUFAL, SHELLY JEAN (LPC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:JEAN
Last Name:COUFAL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 VICTORIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8216
Mailing Address - Country:US
Mailing Address - Phone:936-662-6125
Mailing Address - Fax:979-227-7694
Practice Address - Street 1:6750 VICTORIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8216
Practice Address - Country:US
Practice Address - Phone:936-662-6125
Practice Address - Fax:979-227-7694
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional