Provider Demographics
NPI:1760083794
Name:FLATT, SUSAN CAROL
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:FLATT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HERITAGE HILLS CIR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-5156
Mailing Address - Country:US
Mailing Address - Phone:423-813-9326
Mailing Address - Fax:
Practice Address - Street 1:415 HERITAGE HILLS CIR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-5156
Practice Address - Country:US
Practice Address - Phone:423-813-9326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-20-142323106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician