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General NPI Number Information
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NPI Number | 1104972371
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Entity Type | Individual
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Provider Name | SUSAN G. CLYNES LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8350 MEADOW RD STE 272
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City | DALLAS
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State | TX
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Zip | 75231-0334
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Country | US
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Telephone | 214-226-0667
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Fax | 214-357-2240
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Provider Business Mailing Address
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Address Line | 3506 FLAIR DR
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City | DALLAS
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State | TX
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Zip | 75229-2604
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Country | US
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Telephone | 214-226-0667
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Fax | 214-357-2240
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22869
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License Number State | TX
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