Provider Demographics
NPI:1407897101
Name:CURTIS, SUSAN (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4527 S 2300 E
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4446
Mailing Address - Country:US
Mailing Address - Phone:801-272-0762
Mailing Address - Fax:801-274-3411
Practice Address - Street 1:4527 S 2300 E
Practice Address - Street 2:SUITE 206
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4446
Practice Address - Country:US
Practice Address - Phone:801-272-0762
Practice Address - Fax:801-274-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT333440-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87-0635593Medicaid