Provider Demographics
NPI:1023184579
Name:LUALLEN, SUSAN LEA (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:LEA
Last Name:LUALLEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 CHICO RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928
Mailing Address - Country:US
Mailing Address - Phone:530-343-8886
Mailing Address - Fax:
Practice Address - Street 1:564 RIO LINDO AVENUE
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926
Practice Address - Country:US
Practice Address - Phone:530-879-3950
Practice Address - Fax:530-879-3949
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42259OtherBOARD OF BEHAVIORAL SCIEN