Provider Demographics
NPI:1457118143
Name:RUDOLPH, SUZANNE BRIDGES (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BRIDGES
Last Name:RUDOLPH
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TIMBER VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76085-1658
Mailing Address - Country:US
Mailing Address - Phone:361-548-6964
Mailing Address - Fax:
Practice Address - Street 1:106 AUSTIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-3381
Practice Address - Country:US
Practice Address - Phone:361-548-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional