Provider Demographics
NPI:1174184071
Name:THOMAS, SUSAN (LPC, MED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC, MED
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, MED
Mailing Address - Street 1:8237 MID CITIES BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-4712
Mailing Address - Country:US
Mailing Address - Phone:817-307-1201
Mailing Address - Fax:
Practice Address - Street 1:8237 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4712
Practice Address - Country:US
Practice Address - Phone:817-307-1201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17087101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor