Provider Demographics
NPI:1861134843
Name:DOSS, SUSANNA MARI
Entity type:Individual
Prefix:MS
First Name:SUSANNA
Middle Name:MARI
Last Name:DOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 LISTER DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-2119
Mailing Address - Country:US
Mailing Address - Phone:254-716-0115
Mailing Address - Fax:
Practice Address - Street 1:8414 OLD MCGREGOR RD UNIT B
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6496
Practice Address - Country:US
Practice Address - Phone:254-716-0115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical