Provider Demographics
NPI:1407961626
Name:PACKWOOD, SUSAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:PACKWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:281-265-7311
Mailing Address - Fax:281-265-4683
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:281-265-7311
Practice Address - Fax:281-265-4683
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3592106H00000X
TX06167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026642OtherVALUE OPTIONS
TXOOU32PMedicare ID - Type UnspecifiedGROUP PROVIDER #
TX81410WMedicare ID - Type UnspecifiedPERFORMING PROVIDER