Provider Demographics
NPI:1457479578
Name:JOHNSON, SUSANNE CATHERINE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:CATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6250 E DOVE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-5200
Mailing Address - Country:US
Mailing Address - Phone:480-488-2342
Mailing Address - Fax:
Practice Address - Street 1:11 SUNDIAL CIRCLE
Practice Address - Street 2:SUITE #4
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377
Practice Address - Country:US
Practice Address - Phone:623-340-2342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional