Provider Demographics
NPI:1225201189
Name:SUTTON, SUSAN CHRISTINE (LPCC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 UTE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1422
Mailing Address - Country:US
Mailing Address - Phone:505-982-9869
Mailing Address - Fax:
Practice Address - Street 1:128 GRANT AVE
Practice Address - Street 2:#215
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2031
Practice Address - Country:US
Practice Address - Phone:505-982-9869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6773101YM0800X
NM0092291101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health