Provider Demographics
NPI:1629466057
Name:OLIVER, SUSAN CLAUDETTE (MED, LPC-S)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLAUDETTE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 BENTWATER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-5581
Mailing Address - Country:US
Mailing Address - Phone:325-280-8833
Mailing Address - Fax:
Practice Address - Street 1:1205 BENTWATER PKWY
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-5581
Practice Address - Country:US
Practice Address - Phone:325-280-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional