Provider Demographics
NPI:1003231739
Name:STANTON, SUSAN E (PLC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:STANTON
Suffix:
Gender:F
Credentials:PLC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:480 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3639
Mailing Address - Country:US
Mailing Address - Phone:907-347-2160
Mailing Address - Fax:
Practice Address - Street 1:480 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3639
Practice Address - Country:US
Practice Address - Phone:907-347-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK830101Y00000X, 101YP2500X
AK4051697101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool