Provider Demographics
NPI:1396151700
Name:SUSAN D GIFFORD PHD, PC
Entity type:Organization
Organization Name:SUSAN D GIFFORD PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-858-6745
Mailing Address - Street 1:3508 HIGHWAY 121
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3125
Mailing Address - Country:US
Mailing Address - Phone:817-858-6745
Mailing Address - Fax:866-341-1114
Practice Address - Street 1:3508 HIGHWAY 121
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3125
Practice Address - Country:US
Practice Address - Phone:817-858-6745
Practice Address - Fax:866-341-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36622103TC0700X
TX2-2020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty