Provider Demographics
NPI:1891711586
Name:BEESON, SUZANNE OBRIEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:OBRIEN
Last Name:BEESON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MEDICAL ARTS. BLVD.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011
Mailing Address - Country:US
Mailing Address - Phone:765-298-5353
Mailing Address - Fax:765-298-4988
Practice Address - Street 1:1210 MEDICAL ARTS. BLVD.
Practice Address - Street 2:SUITE 208
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011
Practice Address - Country:US
Practice Address - Phone:765-298-5353
Practice Address - Fax:765-298-4988
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041045A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20041045AOtherSTATE LICENSE
IN179710Medicare ID - Type Unspecified