Provider Demographics
NPI:1043245715
Name:HARRISON, SUE ANN (LPC)
Entity Type:Individual
Prefix:
First Name:SUE ANN
Middle Name:
Last Name:HARRISON
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 1:5262 S STAPLES ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4116
Mailing Address - Country:US
Mailing Address - Phone:361-985-9200
Mailing Address - Fax:361-854-6624
Practice Address - Street 1:5262 S STAPLES ST
Practice Address - Street 2:SUITE 300
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4116
Practice Address - Country:US
Practice Address - Phone:361-985-9200
Practice Address - Fax:361-854-6624
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7095LCOtherBCBS
TX356688OtherMHN
TX7223362OtherAETNA
TX251183OtherVALUE OPTIONS
TX259397OtherCOMPSYCH