Provider Demographics
NPI:1649537044
Name:CIZMAS, SUSAN M (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:CIZMAS
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 1:4209 GATEWAY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-7918
Mailing Address - Country:US
Mailing Address - Phone:214-853-1607
Mailing Address - Fax:817-456-7890
Practice Address - Street 1:4209 GATEWAY DR STE 200
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7918
Practice Address - Country:US
Practice Address - Phone:214-853-1607
Practice Address - Fax:817-456-7890
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional