Provider Demographics
NPI:1386738094
Name:MENGDEN, SUSAN C (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:MENGDEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HEIMER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5032
Mailing Address - Country:US
Mailing Address - Phone:210-253-9763
Mailing Address - Fax:210-255-1681
Practice Address - Street 1:140 HEIMER RD STE 400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5032
Practice Address - Country:US
Practice Address - Phone:210-253-9763
Practice Address - Fax:210-255-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035992901Medicaid
TX2119581OtherCIGNA BEHAVIORAL
TX035992901Medicaid