Provider Demographics
NPI:1043599525
Name:DENDTLER, SUSAN (LPC- MHSP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:DENDTLER
Suffix:
Gender:F
Credentials:LPC- MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 CHAMBERLAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-2909
Mailing Address - Country:US
Mailing Address - Phone:512-213-9813
Mailing Address - Fax:
Practice Address - Street 1:1406 CHAMBERLAIN AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-2909
Practice Address - Country:US
Practice Address - Phone:931-576-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67879101YP2500X
TN4294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional