Provider Demographics
NPI:1619042611
Name:KEISTER, SUSANNE M (LPCC)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:M
Last Name:KEISTER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 S WEST ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4842
Mailing Address - Country:US
Mailing Address - Phone:419-222-7180
Mailing Address - Fax:419-228-8439
Practice Address - Street 1:222 S WEST ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4842
Practice Address - Country:US
Practice Address - Phone:419-222-7180
Practice Address - Fax:419-228-8439
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health