Provider Demographics
NPI:1124410089
Name:SUSAN KRALICH
Entity Type:Organization
Organization Name:SUSAN KRALICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL CLINICAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRALICH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:937-776-6428
Mailing Address - Street 1:3221 RIDGEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1156
Mailing Address - Country:US
Mailing Address - Phone:937-776-6428
Mailing Address - Fax:
Practice Address - Street 1:3221 RIDGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45409-1156
Practice Address - Country:US
Practice Address - Phone:937-776-6428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1000162251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health