Provider Demographics
NPI:1225182850
Name:FRED, SUSANNE MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARIE
Last Name:FRED
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 1:1452 HUGHES RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7366
Mailing Address - Country:US
Mailing Address - Phone:817-410-5770
Mailing Address - Fax:972-393-4119
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:SUITE 211
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7366
Practice Address - Country:US
Practice Address - Phone:817-410-5770
Practice Address - Fax:972-393-4119
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18678101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional