Provider Demographics
NPI:1053987693
Name:SHEWCRAFT, LORI MARIE
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MARIE
Last Name:SHEWCRAFT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 SKYLARK WAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5087
Mailing Address - Country:US
Mailing Address - Phone:800-683-8529
Mailing Address - Fax:
Practice Address - Street 1:4029 SKYLARK WAY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5087
Practice Address - Country:US
Practice Address - Phone:800-683-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty