Provider Demographics
NPI:1558969816
Name:MERRITT, SUZAN MAE (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:MAE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:GUNTER
Mailing Address - State:TX
Mailing Address - Zip Code:75058-2113
Mailing Address - Country:US
Mailing Address - Phone:972-512-8234
Mailing Address - Fax:
Practice Address - Street 1:406 W OAK ST
Practice Address - Street 2:
Practice Address - City:GUNTER
Practice Address - State:TX
Practice Address - Zip Code:75058-2113
Practice Address - Country:US
Practice Address - Phone:972-512-8234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX139040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical