Provider Demographics
NPI:1447951447
Name:RAYFORD, SHANTEL (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHANTEL
Middle Name:
Last Name:RAYFORD
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 1:25807 WESTHEIMER PKWY STE 302
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-5342
Mailing Address - Country:US
Mailing Address - Phone:832-862-5950
Mailing Address - Fax:346-396-3590
Practice Address - Street 1:25807 WESTHEIMER PKWY STE 302
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-5342
Practice Address - Country:US
Practice Address - Phone:832-862-5950
Practice Address - Fax:346-396-3590
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251B00000X
TX89804101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty