Provider Demographics
NPI:1902977622
Name:PERMENTER, SUE A (LCSW)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:A
Last Name:PERMENTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 580601
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77258-0601
Mailing Address - Country:US
Mailing Address - Phone:281-333-3010
Mailing Address - Fax:
Practice Address - Street 1:18100 UPPER BAY RD STE 103
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3530
Practice Address - Country:US
Practice Address - Phone:281-333-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX091401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S82JMedicare ID - Type Unspecified