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General NPI Number Information
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NPI Number | 1932520574
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Entity Type | Organization
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Legal Business Name | SUSAN LAUTZ LPC
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Dates
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Enumeration Date | 12/29/2013
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Last Update Date | 12/29/2013
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Provider Practice Location Address
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Address Line | 206 LEE ST
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City | TERRELL
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State | TX
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Zip | 75160-3019
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Country | US
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Telephone | 214-868-0050
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Fax | 972-551-0350
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Provider Business Mailing Address
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Address Line | PO BOX 2001
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City | FORNEY
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State | TX
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Zip | 75126-2001
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Country | US
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Telephone | 214-868-0050
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Fax | 972-551-0350
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN COOLEY LAUTZ
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Credential | LPC
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Telephone | 214-868-0050
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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 | 63879
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License Number State | TX
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