Provider Demographics
NPI:1790840460
Name:ABRAHAMS, SUSAN H (MA, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:H
Last Name:ABRAHAMS
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 N NEW ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-3111
Mailing Address - Country:US
Mailing Address - Phone:660-665-2703
Mailing Address - Fax:
Practice Address - Street 1:218 N NEW ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3111
Practice Address - Country:US
Practice Address - Phone:660-665-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001988101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001988OtherSTATE LICENSE