Provider Demographics
NPI:1083961932
Name:KING, SUSIE MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSIE
Middle Name:MICHELLE
Last Name:KING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 FELKINS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3008
Mailing Address - Country:US
Mailing Address - Phone:805-302-7654
Mailing Address - Fax:
Practice Address - Street 1:120 FELKINS RD
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3008
Practice Address - Country:US
Practice Address - Phone:805-620-7378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30584103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty