=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578673810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN STEELY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6755 PHELAN BLVD SUITE 24-K
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77706-6075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-553-6156
-----------------------------------------------------
Fax | 409-553-6156
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 445 BERRY RD
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77706-5306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-553-6156
-----------------------------------------------------
Fax | 409-861-3717
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 13458
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------