Provider Demographics
NPI:1730682980
Name:RUTLEDGE, SUSAN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RUTLEDGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 CLOUDCROFT LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-4413
Mailing Address - Country:US
Mailing Address - Phone:214-213-5383
Mailing Address - Fax:
Practice Address - Street 1:101 W RENNER RD STE 220
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2081
Practice Address - Country:US
Practice Address - Phone:972-441-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional