Provider Demographics
NPI:1164416970
Name:LASSITER, SUSAN YAP (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:YAP
Last Name:LASSITER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:YAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:7452 E KIOWA AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-6239
Mailing Address - Country:US
Mailing Address - Phone:480-250-6602
Mailing Address - Fax:
Practice Address - Street 1:288 N IRONWOOD DR
Practice Address - Street 2:110
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3830
Practice Address - Country:US
Practice Address - Phone:480-982-2356
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10907101YP2500X
NC3684101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ426315OtherVALUE OPTIONS PROVIDER
AZ159731OtherMHN MANAGED CARE PANEL