Provider Demographics
NPI:1992010334
Name:LOF, SUSAN SHERIDAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:SHERIDAN
Last Name:LOF
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 SW FRANKLIN CT
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-5133
Mailing Address - Country:US
Mailing Address - Phone:580-231-0428
Mailing Address - Fax:
Practice Address - Street 1:675 SW FRANKLIN CT
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-5133
Practice Address - Country:US
Practice Address - Phone:580-231-0428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60448959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health