Provider Demographics
NPI:1821038845
Name:DAVIS, SUE ELLEN (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUE
Middle Name:ELLEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 PARADISE ST
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-8111
Mailing Address - Country:US
Mailing Address - Phone:940-553-1631
Mailing Address - Fax:940-553-1631
Practice Address - Street 1:1914 PARADISE ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-8111
Practice Address - Country:US
Practice Address - Phone:940-553-1631
Practice Address - Fax:940-553-1631
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4062LCOtherBLUE SHIELD