Provider Demographics
NPI:1710036058
Name:PERRY, SUSAN LEE (EDD LPC LMFT)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LEE
Last Name:PERRY
Suffix:
Gender:F
Credentials:EDD LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5934 S STAPLES
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413
Mailing Address - Country:US
Mailing Address - Phone:361-994-0387
Mailing Address - Fax:361-994-1190
Practice Address - Street 1:5934 S STAPLES
Practice Address - Street 2:SUITE 206
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413
Practice Address - Country:US
Practice Address - Phone:361-994-0387
Practice Address - Fax:361-994-1190
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05015LPC101Y00000X
TX001290LMFT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist