Provider Demographics
NPI:1346596426
Name:SUAREZ, ANTHONY L (LPCA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:SUAREZ
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 RIDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-4163
Mailing Address - Country:US
Mailing Address - Phone:407-408-7268
Mailing Address - Fax:
Practice Address - Street 1:1406 E JOLIET ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4724
Practice Address - Country:US
Practice Address - Phone:219-736-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA9314101YP2500X
IN39003630A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional