Provider Demographics
NPI:1205290889
Name:JEFFERSON, SINDHU SUSAN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:SINDHU
Middle Name:SUSAN
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 DI ORIO DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4254
Mailing Address - Country:US
Mailing Address - Phone:214-864-9751
Mailing Address - Fax:
Practice Address - Street 1:1075 KINWEST PKWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3426
Practice Address - Country:US
Practice Address - Phone:972-910-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional