Provider Demographics
NPI:1730608506
Name:CHESTER, MARY SUSAN (MA LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:CHESTER
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 AUTUMN RUN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-1371
Mailing Address - Country:US
Mailing Address - Phone:972-342-7326
Mailing Address - Fax:
Practice Address - Street 1:255 ELK DR STE B
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8691
Practice Address - Country:US
Practice Address - Phone:817-888-8131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional