Provider Demographics
NPI:1417982372
Name:HEWITT, SUE H (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:H
Last Name:HEWITT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 GALVESTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-4224
Mailing Address - Country:US
Mailing Address - Phone:281-412-4123
Mailing Address - Fax:281-412-4221
Practice Address - Street 1:2501 GALVESTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4224
Practice Address - Country:US
Practice Address - Phone:281-412-4123
Practice Address - Fax:281-412-4221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095901702Medicaid