1104077957 NPI number — MS. SUSAN LYNNE POCASANGRE LPC, LSOTP

Table of content: MS. SUSAN LYNNE POCASANGRE LPC, LSOTP (NPI 1104077957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104077957 NPI number — MS. SUSAN LYNNE POCASANGRE LPC, LSOTP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POCASANGRE
Provider First Name:
SUSAN
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LSOTP
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:
1104077957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2910 COMMERCIAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 103-206
Provider Business Mailing Address City Name:
KATY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77494-6583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-705-8049
Provider Business Mailing Address Fax Number:
713-776-9759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9100 SOUTHWEST FWY
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77074-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-705-8049
Provider Business Practice Location Address Fax Number:
713-776-9759
Provider Enumeration Date:
10/09/2008

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: 101Y00000X , with the licence number:  99063 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 17855 , 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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