Provider Demographics
NPI:1568080216
Name:GREENHOE, SUSAN MAUD (LPCC LADC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MAUD
Last Name:GREENHOE
Suffix:
Gender:F
Credentials:LPCC LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13895 INDUSTRIAL PARK BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3712
Mailing Address - Country:US
Mailing Address - Phone:763-559-5677
Mailing Address - Fax:
Practice Address - Street 1:13895 INDUSTRIAL PARK BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-3712
Practice Address - Country:US
Practice Address - Phone:763-559-5677
Practice Address - Fax:763-559-2116
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304020101YA0400X
MN1842101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)