Provider Demographics
NPI:1598882359
Name:WEEKS, SUSAN (MS, RN, LMFT, LCDC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:WEEKS
Suffix:
Gender:F
Credentials:MS, RN, LMFT, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 MALVEY AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-5100
Mailing Address - Country:US
Mailing Address - Phone:817-737-5599
Mailing Address - Fax:817-737-5757
Practice Address - Street 1:5608 MALVEY AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5100
Practice Address - Country:US
Practice Address - Phone:817-737-5599
Practice Address - Fax:817-737-5757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3902101YA0400X
TX1815106H00000X
TX520122364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCCP004944Medicaid