Provider Demographics
NPI:1932520574
Name:SUSAN LAUTZ LPC
Entity type:Organization
Organization Name:SUSAN LAUTZ LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:COOLEY
Authorized Official - Last Name:LAUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-868-0050
Mailing Address - Street 1:PO BOX 2001
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-2001
Mailing Address - Country:US
Mailing Address - Phone:214-868-0050
Mailing Address - Fax:972-551-0350
Practice Address - Street 1:206 LEE ST
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3019
Practice Address - Country:US
Practice Address - Phone:214-868-0050
Practice Address - Fax:972-551-0350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-29
Last Update Date:2013-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty