Provider Demographics
NPI:1770811374
Name:LADD, LUSAN D (LMFT, LPC)
Entity type:Individual
Prefix:
First Name:LUSAN
Middle Name:D
Last Name:LADD
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 S W S YOUNG DR STE 104A
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3312
Mailing Address - Country:US
Mailing Address - Phone:254-519-1150
Mailing Address - Fax:254-519-1151
Practice Address - Street 1:3800 S W S YOUNG DR STE 104A
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3312
Practice Address - Country:US
Practice Address - Phone:254-519-1150
Practice Address - Fax:254-519-1151
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64044101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX207663002Medicaid