Provider Demographics
NPI:1962650259
Name:SCHLOSSER, SUSAN (LMFT, LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SCHLOSSER
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:SCHLOSSER
Other - Last Name:SHEPARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC; LMFT
Mailing Address - Street 1:4516 BOAT CLUB RD STE 106
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-7020
Mailing Address - Country:US
Mailing Address - Phone:682-556-9096
Mailing Address - Fax:817-238-8333
Practice Address - Street 1:4516 BOAT CLUB RD STE 106
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-7020
Practice Address - Country:US
Practice Address - Phone:817-238-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17834106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3900789Medicaid