Provider Demographics
NPI:1205820198
Name:KAUFFMAN, SUSAN K (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1157
Mailing Address - Street 2:
Mailing Address - City:MC CAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30555-1157
Mailing Address - Country:US
Mailing Address - Phone:941-780-4192
Mailing Address - Fax:706-964-6111
Practice Address - Street 1:146 DEPOT ST STE 202
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-8503
Practice Address - Country:US
Practice Address - Phone:706-964-6111
Practice Address - Fax:706-964-6111
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5963OtherBCBS
FL421634908OtherFEDERAL TAX ID