MEDICARE: MS. PATRICIA GERTA SUSMAN LPC

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	11706	TX

General Provider Information

NPI Number	:	1871591008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA GERTA SUSMAN LPC

Provider Business Mailing Address
First Line	:	10350 BRIAR DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77042-1213
Country	:	US
Telephone Number	:	713-781-2170
Fax Number	:	713-781-2176

Provider Business Practice Location Address
First Line	:	2450 FONDREN RD
Second Line	:	SUITE 312
City	:	HOUSTON
State	:	TX
Zip	:	77063-2318
Country	:	US
Telephone Number	:	712-789-7560
Fax Number	:	713-789-7351

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/08/2007

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