Provider Demographics
NPI:1770959231
Name:HAN, SUE (PSYD)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:HAN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 FM 2181 STE 230-143
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4230
Mailing Address - Country:US
Mailing Address - Phone:815-200-8846
Mailing Address - Fax:
Practice Address - Street 1:4251 FM 2181 STE 230-143
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-4230
Practice Address - Country:US
Practice Address - Phone:815-200-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39951103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical