1285728428 NPI number — MS. SUE ELLEN BADRAK MA LPC LMFT

Table of content: MS. SUE ELLEN BADRAK MA LPC LMFT (NPI 1285728428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285728428 NPI number — MS. SUE ELLEN BADRAK MA LPC LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BADRAK
Provider First Name:
SUE
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LPC LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285728428
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 SUGAR GROVE BLVD
Provider Second Line Business Mailing Address:
350
Provider Business Mailing Address City Name:
STAFFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77477-2148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-491-5400
Provider Business Mailing Address Fax Number:
281-491-3565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 SUGAR GROVE BLVD
Provider Second Line Business Practice Location Address:
350
Provider Business Practice Location Address City Name:
STAFFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77477-2148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-491-5400
Provider Business Practice Location Address Fax Number:
281-491-3565
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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