Provider Demographics
NPI:1821389560
Name:MAXFIELD, SUSAN LYNN (MS, LMFT)
Entity Type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:LYNN
Last Name:MAXFIELD
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 MALVASIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-7843
Mailing Address - Country:US
Mailing Address - Phone:559-750-7518
Mailing Address - Fax:559-686-7920
Practice Address - Street 1:1029 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4117
Practice Address - Country:US
Practice Address - Phone:559-750-7518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48920106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist