MEDICARE: MRS. SUSAN QUINET HEAVRIN MS, LMFT

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	106H00000X	Marriage & Family Therapist	1084	KS
2	106H00000X	Marriage & Family Therapist	202956	TX

General Provider Information

NPI Number	:	1881927499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN QUINET HEAVRIN MS, LMFT

Provider Business Mailing Address
First Line	:	17714 SYCAMORE SHOALS LN
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-3871
Country	:	US
Telephone Number	:	281-801-5828
Fax Number	:

Provider Business Practice Location Address
First Line	:	17904 W LAKE HOUSTON PKWY STE 401
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-0002
Country	:	US
Telephone Number	:	281-801-5828
Fax Number	:

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

Provider Enumeration Date	:	09/14/2009
Last Update Date	:	07/09/2025

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