Provider Demographics
NPI:1891095485
Name:MYHRS, SUSANNE (LMSW)
Entity Type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:MYHRS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 S TELEGRAPH RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-0950
Mailing Address - Country:US
Mailing Address - Phone:248-322-0001
Mailing Address - Fax:248-322-0004
Practice Address - Street 1:10785 S SAGINAW ST
Practice Address - Street 2:SUITE A, BUILDING E
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7003
Practice Address - Country:US
Practice Address - Phone:810-695-0055
Practice Address - Fax:810-695-6813
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-28
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010708061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical