Provider Demographics
NPI:1336362151
Name:JUSTICE, SUSAN B (PHD IN PSYCHOLOGY)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:PHD IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 PARK WEST BLVD., SUITE D-1
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4420
Mailing Address - Country:US
Mailing Address - Phone:865-691-2425
Mailing Address - Fax:865-531-8440
Practice Address - Street 1:9217 PARK WEST BLVD.,
Practice Address - Street 2:SUITE D-1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4420
Practice Address - Country:US
Practice Address - Phone:865-691-2425
Practice Address - Fax:865-531-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1451103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3682847Medicare ID - Type Unspecified