Provider Demographics
NPI:1114039310
Name:BRIANS, SUZANNE (MS)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BRIANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SHILOH RD STE 1205
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-2458
Mailing Address - Country:US
Mailing Address - Phone:430-288-1629
Mailing Address - Fax:903-747-8024
Practice Address - Street 1:1820 SHILOH RD STE 1205
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2458
Practice Address - Country:US
Practice Address - Phone:430-288-1629
Practice Address - Fax:903-747-8024
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095315005Medicaid