Provider Demographics
NPI:1073384491
Name:PELEAZ, SUSANNAH BROOKE (P-LPC)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:BROOKE
Last Name:PELEAZ
Suffix:
Gender:F
Credentials:P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13212 WESTMINSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4386
Mailing Address - Country:US
Mailing Address - Phone:601-508-2898
Mailing Address - Fax:
Practice Address - Street 1:1450 NORTH ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-2103
Practice Address - Country:US
Practice Address - Phone:228-701-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-1052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional