Provider Demographics
NPI:1487917902
Name:RICHEY, SHIRLEY JEAN (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEAN
Last Name:RICHEY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3036
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3036
Mailing Address - Country:US
Mailing Address - Phone:361-571-1844
Mailing Address - Fax:
Practice Address - Street 1:5606 N NAVARRO ST
Practice Address - Street 2:SUITE 109
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1727
Practice Address - Country:US
Practice Address - Phone:361-571-1844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69993101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional