Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 36825 | TX |
Y | 103T00000X | Psychologist | 36825 | TX |
NPI | 1013464791 |
---|---|
Provider Name | Anne Su |
First Address | Houston, TX 77098-3905 |
Second Address | Houston, TX 77098-3905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 09/09/2016 |