Healthcare Provider Details

I. General information

NPI: 1447479316
Provider Name (Legal Business Name): SUSAN CALHOUN MATHIS LPCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7537 BOSQUE BLVD
WACO TX
76712-3713
US

IV. Provider business mailing address

7537 BOSQUE BLVD
WACO TX
76712-3713
US

V. Phone/Fax

Practice location:
  • Phone: 254-776-3235
  • Fax: 254-776-7405
Mailing address:
  • Phone: 254-776-3235
  • Fax: 254-776-7405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: