Provider Demographics
NPI:1699818906
Name:SYNAN, SUSAN GRACE (MA,LPC,LCDC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:GRACE
Last Name:SYNAN
Suffix:
Gender:F
Credentials:MA,LPC,LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 TIMBER SHADOWS DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2041
Mailing Address - Country:US
Mailing Address - Phone:713-907-0882
Mailing Address - Fax:
Practice Address - Street 1:2330 TIMBER SHADOWS DR
Practice Address - Street 2:SUITE 208
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2041
Practice Address - Country:US
Practice Address - Phone:713-907-0882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3613101YA0400X
TX10229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional