MEDICARE: DR. SUSAN JAN FRENSLEY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	34188	TX

General Provider Information

NPI Number	:	1295969996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN JAN FRENSLEY PHD

Provider Business Mailing Address
First Line	:	704 N CROCKETT AVE
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520-2551
Country	:	US
Telephone Number	:	830-637-9615
Fax Number	:	972-852-7992

Provider Business Practice Location Address
First Line	:	704 N CROCKETT AVE
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520-2551
Country	:	US
Telephone Number	:	830-637-9615
Fax Number	:	972-852-7992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2009
Last Update Date	:	03/29/2011

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