Provider Demographics
NPI:1063678811
Name:EDISON-HARRIS, SUSANNE J (LPC-MH, QMHP, LAC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:J
Last Name:EDISON-HARRIS
Suffix:
Gender:F
Credentials:LPC-MH, QMHP, LAC
Other - Prefix:
Other - First Name:SUSANNE
Other - Middle Name:J
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4109 S CARNEGIE CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-2321
Mailing Address - Country:US
Mailing Address - Phone:605-331-2419
Mailing Address - Fax:605-789-8026
Practice Address - Street 1:4109 S CARNEGIE CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-2321
Practice Address - Country:US
Practice Address - Phone:605-331-2419
Practice Address - Fax:605-789-8026
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC1115101YM0800X, 101YM0800X
SD04091200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health