Provider Demographics
NPI:1205819976
Name:HARTMAN, SUSAN RENEE (LPC,CEAP,NCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LPC,CEAP,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11120 WURZBACH RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2424
Mailing Address - Country:US
Mailing Address - Phone:210-691-2100
Mailing Address - Fax:210-691-2110
Practice Address - Street 1:11120 WURZBACH RD
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2424
Practice Address - Country:US
Practice Address - Phone:210-691-2100
Practice Address - Fax:210-691-2110
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8700101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health