Provider Demographics
NPI:1609992841
Name:DEAN, SUSAN (MCP,NCC,LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MCP,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39201-1108
Mailing Address - Country:US
Mailing Address - Phone:601-949-1949
Mailing Address - Fax:
Practice Address - Street 1:431 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39201-1108
Practice Address - Country:US
Practice Address - Phone:601-949-1949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS864101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional