Provider Demographics
NPI:1316113582
Name:FLETCHER, SUSAN HENDERSON (PH D)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:HENDERSON
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR
Mailing Address - Street 2:STE 135
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3992
Mailing Address - Country:US
Mailing Address - Phone:972-612-1188
Mailing Address - Fax:
Practice Address - Street 1:2301 OHIO DRIVE
Practice Address - Street 2:SUITE 135
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3992
Practice Address - Country:US
Practice Address - Phone:972-612-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26858103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5654OtherLICENSED SPECIALIST SCHOOL PSYCHOLOGY (LSSP)
TX44612OtherNATIONAL HEALTH SERVICE PROVIDER
TX26858OtherLICENSED PSYCHOLOGIST NUMBER