Healthcare Provider Details

I. General information

NPI: 1801516273
Provider Name (Legal Business Name): SUSAN BLANCHARD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/29/2022
Certification Date: 08/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 ROOSEVELT DR STE B
ARLINGTON TX
76016-5888
US

IV. Provider business mailing address

1133 W TUCKER BLVD
ARLINGTON TX
76013-5112
US

V. Phone/Fax

Practice location:
  • Phone: 682-717-1156
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: