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General NPI Number Information
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NPI Number | 1245659572
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Entity Type | Individual
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Provider Name | SUSETTE MARIE VILLEGAS LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 3411 CEDAR KNOLLS DR SUITE K
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City | KINGWOOD
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State | TX
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Zip | 77339-2482
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Country | US
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Telephone | 832-802-9667
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Fax | 888-468-6184
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Provider Business Mailing Address
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Address Line | 13219 CLOVER CREEK POINT LN
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City | HUMBLE
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State | TX
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Zip | 77346-3842
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Country | US
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Telephone | 832-802-9667
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Fax | 888-468-6184
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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 | 52972
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License Number State | TX
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