Provider Demographics
NPI:1427188705
Name:STUCKEY, SUSAN H (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:STUCKEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 N 2ND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-5890
Mailing Address - Country:US
Mailing Address - Phone:325-695-0400
Mailing Address - Fax:325-695-0788
Practice Address - Street 1:1133 N 2ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5890
Practice Address - Country:US
Practice Address - Phone:325-695-0400
Practice Address - Fax:325-695-0788
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional