Provider Demographics
NPI:1205812807
Name:MAY, SUSAN (MA, LP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6542 REGENCY LN STE 205
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7848
Mailing Address - Country:US
Mailing Address - Phone:952-356-6526
Mailing Address - Fax:952-903-9257
Practice Address - Street 1:6542 REGENCY LN STE 205
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7848
Practice Address - Country:US
Practice Address - Phone:952-356-6526
Practice Address - Fax:952-903-9257
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4043103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling