Provider Demographics
NPI:1104890144
Name:HAYMAN, SUSAN CHAMBERLAIN (MS LPC-MH QMHP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CHAMBERLAIN
Last Name:HAYMAN
Suffix:
Gender:F
Credentials:MS LPC-MH QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 LELAND LN
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3459
Mailing Address - Country:US
Mailing Address - Phone:605-737-0769
Mailing Address - Fax:605-721-1196
Practice Address - Street 1:2404 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3450
Practice Address - Country:US
Practice Address - Phone:605-737-0769
Practice Address - Fax:605-721-1196
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH 2081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4997001OtherBLUE CROSS/BLUE SHIELD
SD6575560Medicaid