Provider Demographics
NPI:1831667120
Name:MOLINA, SUZETTE (LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CIMARRON PARK LOOP STE 112
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2849
Mailing Address - Country:US
Mailing Address - Phone:512-589-1364
Mailing Address - Fax:
Practice Address - Street 1:112 CIMARRON PARK LOOP STE B
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610
Practice Address - Country:US
Practice Address - Phone:512-589-1364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional