Provider Demographics
NPI:1982220851
Name:SUSANNE GRAHAM
Entity Type:Organization
Organization Name:SUSANNE GRAHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:352-345-9267
Mailing Address - Street 1:6509 OREGON CHICKADEE RD
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-8353
Mailing Address - Country:US
Mailing Address - Phone:352-345-9267
Mailing Address - Fax:
Practice Address - Street 1:11029 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-5049
Practice Address - Country:US
Practice Address - Phone:352-345-9267
Practice Address - Fax:352-592-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-17
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty