Provider Demographics
NPI:1528019551
Name:BRUNSON, SUSAN LINELL (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LINELL
Last Name:BRUNSON
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 1:28515 SAGECREST DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-1420
Mailing Address - Country:US
Mailing Address - Phone:205-641-9869
Mailing Address - Fax:
Practice Address - Street 1:28515 SAGECREST DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1420
Practice Address - Country:US
Practice Address - Phone:205-641-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635341041C0700X
LA12111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P07529Medicare UPIN