Provider Demographics
NPI:1578673810
Name:STEELY, SUSAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:STEELY
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 1:445 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-5306
Mailing Address - Country:US
Mailing Address - Phone:409-553-6156
Mailing Address - Fax:409-861-3717
Practice Address - Street 1:6755 PHELAN BLVD
Practice Address - Street 2:SUITE 24-K
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6075
Practice Address - Country:US
Practice Address - Phone:409-553-6156
Practice Address - Fax:409-553-6156
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13458101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6214 LCOtherBLUE CROSS BLUE SHIELD
TX216198OtherCOM PSYCH
TX0007610683OtherAETNA