Provider Demographics
NPI:1760759468
Name:PIKULA, SUSAN RENEE (MS, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RENEE
Last Name:PIKULA
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:RENEE
Other - Last Name:COLLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW
Mailing Address - Street 1:112 CROWN HILL RD W
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:MN
Mailing Address - Zip Code:55965-1200
Mailing Address - Country:US
Mailing Address - Phone:507-993-2575
Mailing Address - Fax:
Practice Address - Street 1:124 MAIN ST SE STE 2
Practice Address - Street 2:
Practice Address - City:PRESTON
Practice Address - State:MN
Practice Address - Zip Code:55965-1202
Practice Address - Country:US
Practice Address - Phone:507-993-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02550101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health