Provider Demographics
NPI:1922194356
Name:RUCKER, SUSAN (LCMFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 470, BOX 4539
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09165
Mailing Address - Country:US
Mailing Address - Phone:49618-188-9278
Mailing Address - Fax:49618-188-8584
Practice Address - Street 1:USAHC HANAU
Practice Address - Street 2:UNIT 20193, BOX 0030
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09165-0030
Practice Address - Country:US
Practice Address - Phone:49618-188-9278
Practice Address - Fax:49618-188-8584
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM 159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist