Provider Demographics
NPI:1568750800
Name:TRUETT, SUSAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:TRUETT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E BAY ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-4983
Mailing Address - Country:US
Mailing Address - Phone:863-660-6556
Mailing Address - Fax:863-688-3770
Practice Address - Street 1:215 E BAY ST STE 5
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-4983
Practice Address - Country:US
Practice Address - Phone:863-660-6556
Practice Address - Fax:863-688-3770
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5820101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor