Healthcare Provider Details

I. General information

NPI: 1992793889
Provider Name (Legal Business Name): SUSAN CASON-PARKS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5620 OLD BULLARD RD SUITE 111
TYLER TX
75703-4358
US

IV. Provider business mailing address

3913 BROOKWOOD DR
TYLER TX
75701-9685
US

V. Phone/Fax

Practice location:
  • Phone: 903-534-1956
  • Fax: 903-534-1956
Mailing address:
  • Phone: 903-534-1956
  • Fax: 903-534-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35503
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: