Provider Demographics
NPI:1215577176
Name:CLAUSS, SUSAN H
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:CLAUSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3507
Mailing Address - Country:US
Mailing Address - Phone:314-540-4850
Mailing Address - Fax:
Practice Address - Street 1:3402 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3507
Practice Address - Country:US
Practice Address - Phone:314-540-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOLPC001426OtherLICENSED PROFESSIONAL COUNSELOR