Provider Demographics
NPI:1639297369
Name:CRAYTON, SUZETTE MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:MARIE
Last Name:CRAYTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:GUTTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:130 DESIARD ST STE 355
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7363
Mailing Address - Country:US
Mailing Address - Phone:318-807-7875
Mailing Address - Fax:318-812-6603
Practice Address - Street 1:920 OLIVER RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5702
Practice Address - Country:US
Practice Address - Phone:318-807-6258
Practice Address - Fax:318-812-7347
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925748Medicaid