Provider Demographics
NPI:1730427592
Name:WILSON, SUSAN JANE (MED, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:J
Other - Last Name:CATHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1001 S POLK ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-3407
Mailing Address - Country:US
Mailing Address - Phone:806-342-2500
Mailing Address - Fax:806-372-2433
Practice Address - Street 1:1001 S POLK ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-3407
Practice Address - Country:US
Practice Address - Phone:806-342-2500
Practice Address - Fax:806-372-2433
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60718101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional