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General NPI Number Information
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NPI Number | 1649537044
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Entity Type | Individual
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Provider Name | SUSAN M CIZMAS MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4209 GATEWAY DR STE 200
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City | COLLEYVILLE
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State | TX
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Zip | 76034-7918
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Country | US
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Telephone | 214-853-1607
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Fax | 817-456-7890
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Provider Business Mailing Address
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Address Line | 4209 GATEWAY DR STE 200
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City | COLLEYVILLE
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State | TX
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Zip | 76034-7918
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Country | US
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Telephone | 214-853-1607
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Fax | 817-456-7890
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 64194
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License Number State | TX
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