Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 9436 | TX |
NPI | 1003800210 |
---|---|
Provider Name | Ms. Susan E Mcculley |
First Address | Lufkin, TX 75904-3014 |
Second Address | Jasper, TX 75951-3510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2005 |
Last Update Date | 08/07/2007 |