Provider Demographics
NPI:1598186033
Name:MILLER, SUZAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUZAN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 10970
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33733-0970
Mailing Address - Country:US
Mailing Address - Phone:727-327-7656
Mailing Address - Fax:727-322-2110
Practice Address - Street 1:2188 58TH ST N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3112
Practice Address - Country:US
Practice Address - Phone:727-327-7656
Practice Address - Fax:727-322-2110
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 12243101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010387700Medicaid