Healthcare Provider Details

I. General information

NPI: 1841540697
Provider Name (Legal Business Name): SUZANNE EADES PH.D., LP, LSSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 MIDWAY ROAD
DALLAS TX
75220
US

IV. Provider business mailing address

9407 MIDWAY ROAD
DALLAS TX
75220
US

V. Phone/Fax

Practice location:
  • Phone: 214-353-9323
  • Fax: 214-239-2958
Mailing address:
  • Phone: 214-353-9323
  • Fax: 214-239-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number32476
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: