Provider Demographics
NPI:1841540697
Name:EADES, SUZANNE (PHD, LP, LSSP)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:EADES
Suffix:
Gender:F
Credentials:PHD, LP, LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 MIDWAY ROAD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220
Mailing Address - Country:US
Mailing Address - Phone:214-353-9323
Mailing Address - Fax:214-239-2958
Practice Address - Street 1:9407 MIDWAY ROAD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220
Practice Address - Country:US
Practice Address - Phone:214-353-9323
Practice Address - Fax:214-239-2958
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32476103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist