Provider Demographics
NPI:1134132624
Name:DOELL, SUSANNE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSANNE
Middle Name:R
Last Name:DOELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W LYNN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4747
Mailing Address - Country:US
Mailing Address - Phone:512-454-3400
Mailing Address - Fax:512-472-8503
Practice Address - Street 1:913 W LYNN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4782
Practice Address - Country:US
Practice Address - Phone:512-454-3400
Practice Address - Fax:512-472-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23331103TA0400X, 103TC0700X, 103T00000X
TX000790042884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist