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General NPI Number Information
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NPI Number | 1467793695
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Entity Type | Individual
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Provider Name | SUSAN P HARRELSON LMT, CLT-LANA
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Gender | Female
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 18626 HARDY OAK BLVD SUITE 210
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4210
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Country | US
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Telephone | 210-237-4229
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Fax | 210-249-4911
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Provider Business Mailing Address
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Address Line | 5047 SHERRI ANN RD
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City | SAN ANTONIO
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State | TX
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Zip | 78233-6213
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Country | US
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Telephone | 210-237-4400
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Fax | 210-828-0590
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MT016082
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 000573
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License Number State | TX
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