Provider Demographics
NPI:1124418207
Name:ANDERSON, SUSAN MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:JOB
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:3021 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-1940
Mailing Address - Country:US
Mailing Address - Phone:406-294-5090
Mailing Address - Fax:406-294-5091
Practice Address - Street 1:3021 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1940
Practice Address - Country:US
Practice Address - Phone:406-294-5090
Practice Address - Fax:406-294-5091
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSWP-LCPC-477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTSWP-LCPC-477OtherLICENSED CLINICAL PROFESSIONAL COUNSELOR