Individual
MS. MARY LOU SHACKLETON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC, LMFT
Contact information
Practice address
15700 SPACE CENTER BLVD, HOUSTON, TX 77062
(281) 250-1724
Mailing address
PO BOX 590344, HOUSTON, TX 77259-0344
(281) 250-1724
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
19271
TX
106H00000X
Marriage & Family Therapist
Primary
5140
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84558L
BLUECROSSINSURPROVIDER#
TX
Enumeration date
01/28/2007
Last updated
09/23/2009
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