Provider Demographics
NPI:1235956236
Name:SUDDUTH, JOHN G (LPC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:SUDDUTH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 DELAFIELD LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-1310
Mailing Address - Country:US
Mailing Address - Phone:940-206-6879
Mailing Address - Fax:
Practice Address - Street 1:502 E HIGHLAND MALL BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3722
Practice Address - Country:US
Practice Address - Phone:512-854-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85038101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional