MEDICARE: MRS. SUSAN CALHOUN MATHIS LPCS

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	101YP2500X	Professional Counselor	16663	TX

General Provider Information

NPI Number	:	1447479316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN CALHOUN MATHIS LPCS

Provider Business Mailing Address
First Line	:	7537 BOSQUE BLVD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3713
Country	:	US
Telephone Number	:	254-776-3235
Fax Number	:	254-776-7405

Provider Business Practice Location Address
First Line	:	7537 BOSQUE BLVD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3713
Country	:	US
Telephone Number	:	254-776-3235
Fax Number	:	254-776-7405

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	12/15/2025

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