Provider Demographics
NPI:1902941651
Name:CARDWELL, SUSAN J (LPC, MA)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:J
Last Name:CARDWELL
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2304 MIDWESTERN PARKWAY
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2342
Mailing Address - Country:US
Mailing Address - Phone:940-691-1267
Mailing Address - Fax:940-691-1582
Practice Address - Street 1:2304 MIDWESTERN PARKWAY
Practice Address - Street 2:SUITE 103A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2342
Practice Address - Country:US
Practice Address - Phone:940-691-1267
Practice Address - Fax:940-691-1582
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168147001Medicaid
TX84473LOtherBLUE CROSS ID NUMBER