Provider Demographics
NPI:1598772444
Name:YUEN, SUSAN RENAE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RENAE
Last Name:YUEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:RENAE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:3112 O ST
Mailing Address - Street 2:STE #3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6542
Mailing Address - Country:US
Mailing Address - Phone:916-717-5871
Mailing Address - Fax:
Practice Address - Street 1:3112 O ST
Practice Address - Street 2:STE #3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6542
Practice Address - Country:US
Practice Address - Phone:916-717-5871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43357106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist