Provider Demographics
NPI:1184723207
Name:MONSON, SUSAN DIANNE (MED, LPC, RPT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:DIANNE
Last Name:MONSON
Suffix:
Gender:F
Credentials:MED, LPC, RPT
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DIANNE
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 1035
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72757-1035
Mailing Address - Country:US
Mailing Address - Phone:479-631-1189
Mailing Address - Fax:
Practice Address - Street 1:1 HALSTED CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-3185
Practice Address - Country:US
Practice Address - Phone:479-631-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0303007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y345OtherBLUE CROSS/BLUE SHIELD