Provider Demographics
NPI:1588691463
Name:DOESCHER, SUZETTE K (LCSW)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:K
Last Name:DOESCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-0223
Mailing Address - Country:US
Mailing Address - Phone:214-714-8021
Mailing Address - Fax:903-246-3126
Practice Address - Street 1:101 KING PLZ STE A
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428
Practice Address - Country:US
Practice Address - Phone:214-714-8021
Practice Address - Fax:903-246-3126
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX417541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1920092-01Medicaid
TX1920092-01Medicaid