Provider Demographics
NPI:1689859571
Name:LIE, SUZANNE (MFCC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:LIE
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SAPPHIRE ST
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-4257
Mailing Address - Country:US
Mailing Address - Phone:310-540-1313
Mailing Address - Fax:310-540-1322
Practice Address - Street 1:521 SAPPHIRE ST
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-4257
Practice Address - Country:US
Practice Address - Phone:310-540-1313
Practice Address - Fax:310-540-1322
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC22674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist