Healthcare Provider Details

I. General information

NPI: 1134132624
Provider Name (Legal Business Name): SUSANNE R. DOELL PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5602 PARADE RDG # 1
AUSTIN TX
78731-3350
US

IV. Provider business mailing address

5602 PARADE RDG # 1
AUSTIN TX
78731-3350
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-3400
  • Fax:
Mailing address:
  • Phone: 512-454-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number23331
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number23331
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000790042884
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: