Provider Demographics
NPI:1821203415
Name:WHITE, SUSAN J (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:MI
Mailing Address - Zip Code:49061-9742
Mailing Address - Country:US
Mailing Address - Phone:269-816-5031
Mailing Address - Fax:269-244-8913
Practice Address - Street 1:12220 HARVEY ST
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:MI
Practice Address - Zip Code:49061-9742
Practice Address - Country:US
Practice Address - Phone:269-816-5031
Practice Address - Fax:269-244-8913
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006308106H00000X
IN35001563A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist