Provider Demographics
NPI:1093143463
Name:CLARK, SUZANNE JONES (APRN, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:JONES
Last Name:CLARK
Suffix:
Gender:F
Credentials:APRN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8280 YMCA PLAZA DR
Mailing Address - Street 2:10 B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0927
Mailing Address - Country:US
Mailing Address - Phone:225-278-3541
Mailing Address - Fax:225-755-1211
Practice Address - Street 1:8280 YMCA PLAZA DR
Practice Address - Street 2:10 B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0927
Practice Address - Country:US
Practice Address - Phone:225-278-3541
Practice Address - Fax:225-755-1211
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-23
Last Update Date:2021-02-08
Deactivation Date:2019-02-13
Deactivation Code:
Reactivation Date:2019-02-27
Provider Licenses
StateLicense IDTaxonomies
LA4199101YP2500X
LAAP09208363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional