Provider Demographics
NPI:1891274791
Name:ORR, SUSAN MARIE (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:ORR
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37354-0278
Mailing Address - Country:US
Mailing Address - Phone:865-442-2622
Mailing Address - Fax:423-442-5760
Practice Address - Street 1:4798 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37354-1287
Practice Address - Country:US
Practice Address - Phone:423-442-2622
Practice Address - Fax:423-442-5760
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-10
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3956101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health