Provider Demographics
NPI:1134298326
Name:FRISSELL, SUSAN (PHD, LCPC)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:FRISSELL
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4550 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-1825
Mailing Address - Country:US
Mailing Address - Phone:847-224-7506
Mailing Address - Fax:317-929-1161
Practice Address - Street 1:4550 CENTRAL AVE STE 201F
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-1825
Practice Address - Country:US
Practice Address - Phone:847-224-7506
Practice Address - Fax:317-929-1161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILLCPC 180-001112101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health