Provider Demographics
NPI:1275605503
Name:CARUTHERS, SUSAN B (MA,LPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:B
Last Name:CARUTHERS
Suffix:
Gender:F
Credentials:MA,LPC, LMFT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:WENONAH BRUECHNER
Other - Last Name:CARUTHERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:934 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1508
Mailing Address - Country:US
Mailing Address - Phone:318-861-1101
Mailing Address - Fax:
Practice Address - Street 1:1525 STEPHENS ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-221-6121
Practice Address - Fax:318-222-7879
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALMFT 396101YM0800X
LALPC 2879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2879OtherLPC
LA396OtherLMFT