Provider Demographics
NPI:1407831183
Name:CORLEY, SUSAN WALTERS (MALPCRPT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:WALTERS
Last Name:CORLEY
Suffix:
Gender:F
Credentials:MALPCRPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:WALTERS
Other - Last Name:CORLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MALPC
Mailing Address - Street 1:1212 STONEHOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2149
Mailing Address - Country:US
Mailing Address - Phone:281-358-7529
Mailing Address - Fax:281-860-0082
Practice Address - Street 1:1212 STONEHOLLOW DR STE 2
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2290
Practice Address - Country:US
Practice Address - Phone:281-358-7529
Practice Address - Fax:281-312-0068
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12049101YP2500X, 101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health