Provider Demographics
NPI:1235393182
Name:MESSAL, SUSAN MARGARET (LPCC)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:MARGARET
Last Name:MESSAL
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 1:2904 SUDDERTH DR STE B
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6338
Mailing Address - Country:US
Mailing Address - Phone:260-402-1967
Mailing Address - Fax:
Practice Address - Street 1:2904 SUDDERTH DR STE B
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6338
Practice Address - Country:US
Practice Address - Phone:260-402-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0140271101YP2500X
NMT-0111111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health