Provider Demographics
NPI:1174530547
Name:TOMLIN, SUZANNE W (LPC)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:W
Last Name:TOMLIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUZANNE
Other - Middle Name:W
Other - Last Name:CAVENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:13480 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:TX
Mailing Address - Zip Code:75758
Mailing Address - Country:US
Mailing Address - Phone:903-849-3844
Mailing Address - Fax:903-849-3847
Practice Address - Street 1:13480 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:TX
Practice Address - Zip Code:75758
Practice Address - Country:US
Practice Address - Phone:903-714-2597
Practice Address - Fax:903-849-3847
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS796101YP2500X
MO2001013208101YP2500X
TX17645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6504LCOtherBLUE CROSS