Provider Demographics
NPI:1023129137
Name:BRUMM, SUSAN EDITH (LPCC, LMHC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:EDITH
Last Name:BRUMM
Suffix:
Gender:F
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W F ST
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-3734
Mailing Address - Country:US
Mailing Address - Phone:209-404-6283
Mailing Address - Fax:209-848-8825
Practice Address - Street 1:603 W F ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361-3734
Practice Address - Country:US
Practice Address - Phone:209-404-6283
Practice Address - Fax:209-848-8825
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001787A101YM0800X
CA115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health