Provider Demographics
NPI:1942586508
Name:NEDOCK, SHIRLEY (LPC-S)
Entity type:Individual
Prefix:MISS
First Name:SHIRLEY
Middle Name:
Last Name:NEDOCK
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1067 FM 306 STE 402
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6895
Mailing Address - Country:US
Mailing Address - Phone:281-925-7780
Mailing Address - Fax:210-783-1646
Practice Address - Street 1:1067 FM 306 STE 402
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6895
Practice Address - Country:US
Practice Address - Phone:281-925-7780
Practice Address - Fax:210-783-1646
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78304101YM0800X, 251B00000X, 251S00000X, 101YP2500X
NC10203101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX381289301Medicaid