Provider Demographics
NPI:1598780009
Name:BEITLER, SUSAN PENELOPE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:PENELOPE
Last Name:BEITLER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 QUAIL COURT SUITE 200
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8729
Mailing Address - Country:US
Mailing Address - Phone:925-381-8682
Mailing Address - Fax:
Practice Address - Street 1:45 QUAIL COURT SUITE 200
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8729
Practice Address - Country:US
Practice Address - Phone:925-381-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30298106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist