Provider Demographics
NPI:1457683534
Name:LONG, SUSAN BOHN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:BOHN
Last Name:LONG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 DANFORTH CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4931
Mailing Address - Country:US
Mailing Address - Phone:512-415-1687
Mailing Address - Fax:
Practice Address - Street 1:1101 S CAPITAL OF TEXAS HWY
Practice Address - Street 2:BUILDING A SUITE 295
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6445
Practice Address - Country:US
Practice Address - Phone:512-415-1687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX504981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical