Provider Demographics
NPI:1285643643
Name:BAYNE, SUSAN MERYL (LPC, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MERYL
Last Name:BAYNE
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TANNER WOODS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1628
Mailing Address - Country:US
Mailing Address - Phone:210-394-9161
Mailing Address - Fax:
Practice Address - Street 1:12 TANNER WOODS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1628
Practice Address - Country:US
Practice Address - Phone:210-394-9161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09241101YP2500X
TX611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154226802Medicaid
TX128893OtherMANAGED HEALTH NETWORK
TX9259574OtherPHCS
TX044980OtherVALUE OPTIONS
TX1507LCOtherBC/BS