Provider Demographics
NPI:1134611734
Name:MILLICAN, SUZANNE LEE (LMFT)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:LEE
Last Name:MILLICAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PALOS VERDES DR W
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2705
Mailing Address - Country:US
Mailing Address - Phone:310-210-6991
Mailing Address - Fax:
Practice Address - Street 1:235 AVENIDA DEL NORTE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5729
Practice Address - Country:US
Practice Address - Phone:310-210-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT44215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist