Provider Demographics
NPI:1760673396
Name:HAM, SUSAN LYNN (LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:HAM
Suffix:
Gender:F
Credentials:LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 SEABOARD LN
Mailing Address - Street 2:BLDG. E, SUITE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2875
Mailing Address - Country:US
Mailing Address - Phone:615-838-8539
Mailing Address - Fax:
Practice Address - Street 1:256 SEABOARD LN
Practice Address - Street 2:BLDG. E, SUITE 102
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-2875
Practice Address - Country:US
Practice Address - Phone:615-838-8539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2577101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3376955OtherGROUP MEDICARE