Provider Demographics
NPI:1598809410
Name:WEBER, SUSANA ORTIZ (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:ORTIZ
Last Name:WEBER
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 1:4065 FM 953
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954-6244
Mailing Address - Country:US
Mailing Address - Phone:361-277-9115
Mailing Address - Fax:
Practice Address - Street 1:5606 N NAVARRO ST
Practice Address - Street 2:STE. 200D
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1727
Practice Address - Country:US
Practice Address - Phone:361-576-6702
Practice Address - Fax:361-570-6721
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional