MEDICARE: CATHERINE SUDDARTH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	41171	TX

General Provider Information

NPI Number	:	1346639341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE SUDDARTH LCSW

Provider Business Mailing Address
First Line	:	8955 KATY FWY
Second Line	:	SUITE 207
City	:	HOUSTON
State	:	TX
Zip	:	77024-1638
Country	:	US
Telephone Number	:	713-320-5083
Fax Number	:

Provider Business Practice Location Address
First Line	:	8955 KATY FWY
Second Line	:	SUITE 207
City	:	HOUSTON
State	:	TX
Zip	:	77024-1638
Country	:	US
Telephone Number	:	713-320-5083
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2015
Last Update Date	:	01/13/2015

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