Provider Demographics
NPI:1558792531
Name:CARLSON, SUSAN FROESCHLE (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:FROESCHLE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAYE
Other - Last Name:LIND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LP
Mailing Address - Street 1:886 SPRING TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-5901
Mailing Address - Country:US
Mailing Address - Phone:928-713-8671
Mailing Address - Fax:928-445-4551
Practice Address - Street 1:711 WHIPPLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1717
Practice Address - Country:US
Practice Address - Phone:928-713-8671
Practice Address - Fax:928-445-4551
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional