Provider Demographics
NPI:1003938861
Name:SCROGGIN, SUSAN DELORES (MA, LPCC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DELORES
Last Name:SCROGGIN
Suffix:
Gender:F
Credentials:MA, LPCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4501
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-4501
Mailing Address - Country:US
Mailing Address - Phone:505-470-9605
Mailing Address - Fax:505-995-0909
Practice Address - Street 1:1807 2ND ST
Practice Address - Street 2:#58
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-3499
Practice Address - Country:US
Practice Address - Phone:505-995-0091
Practice Address - Fax:505-995-0909
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0065132101YP2500X
NM0094031106H00000X
COLPC.0001063101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist