Provider Demographics
NPI:1871926865
Name:MUMPHORD, SHIRLEY ANN (LPC)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:MUMPHORD
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 1:225 N VIRGINIA ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PORT LAVACA
Mailing Address - State:TX
Mailing Address - Zip Code:77979-3430
Mailing Address - Country:US
Mailing Address - Phone:361-482-0427
Mailing Address - Fax:361-482-0426
Practice Address - Street 1:225 N VIRGINIA ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PORT LAVACA
Practice Address - State:TX
Practice Address - Zip Code:77979-3430
Practice Address - Country:US
Practice Address - Phone:361-482-0427
Practice Address - Fax:361-482-0426
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1565101YP2500X
TX101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool