Provider Demographics
NPI:1083761902
Name:DOVENMUEHLE, SUSAN BOYD (MS, LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BOYD
Last Name:DOVENMUEHLE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 N COLLEGE AVE STE 210B
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3955
Mailing Address - Country:US
Mailing Address - Phone:812-332-3750
Mailing Address - Fax:812-332-0828
Practice Address - Street 1:205 N COLLEGE AVE STE 210B
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3955
Practice Address - Country:US
Practice Address - Phone:812-332-3750
Practice Address - Fax:812-332-0828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000018A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health