Provider Demographics
NPI:1801289046
Name:ODUM, SUZANNE MOUTON (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:MOUTON
Last Name:ODUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1011 AUGUSTA DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2062
Mailing Address - Country:US
Mailing Address - Phone:713-914-9944
Mailing Address - Fax:713-914-9599
Practice Address - Street 1:1011 AUGUSTA DR
Practice Address - Street 2:SUITE 107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2062
Practice Address - Country:US
Practice Address - Phone:713-914-9944
Practice Address - Fax:713-914-9599
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4774103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling