Provider Demographics
NPI:1982857538
Name:SOUTHERN, CLAUDIA P (LPC)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:P
Last Name:SOUTHERN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-0758
Mailing Address - Country:US
Mailing Address - Phone:817-573-6922
Mailing Address - Fax:817-579-6611
Practice Address - Street 1:210 E PEARL ST
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2211
Practice Address - Country:US
Practice Address - Phone:817-573-6922
Practice Address - Fax:817-579-6611
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027764201Medicaid