Provider Demographics
NPI:1346440898
Name:JUSTITZ, SUSAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:JUSTITZ
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 1:1232 WHITEHORSE DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2934
Mailing Address - Country:US
Mailing Address - Phone:214-208-9460
Mailing Address - Fax:972-353-3014
Practice Address - Street 1:1232 WHITEHORSE DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2934
Practice Address - Country:US
Practice Address - Phone:214-208-9460
Practice Address - Fax:972-353-3014
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33456103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling