Provider Demographics
NPI:1417190588
Name:BECKMAN-MITCHELL, SUSAN (LPC, MA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BECKMAN-MITCHELL
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12899 W HERBISON RD
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:MI
Mailing Address - Zip Code:48822-9648
Mailing Address - Country:US
Mailing Address - Phone:517-242-1762
Mailing Address - Fax:517-247-2844
Practice Address - Street 1:12899 W HERBISON RD
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:MI
Practice Address - Zip Code:48822-9648
Practice Address - Country:US
Practice Address - Phone:517-242-1762
Practice Address - Fax:517-247-2844
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-19
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401001487101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8324957Medicaid