Provider Demographics
NPI:1659818201
Name:TEAGUE, SUZANNE Y (LPC, LCDCIII)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:Y
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LPC, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E. ERIE ST.
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077
Mailing Address - Country:US
Mailing Address - Phone:440-350-5669
Mailing Address - Fax:440-350-5668
Practice Address - Street 1:104 E. ERIE ST.
Practice Address - Street 2:
Practice Address - City:PAINSEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-350-5669
Practice Address - Fax:440-350-5668
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011423101YA0400X
OHC5643101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist