Provider Demographics
NPI:1669574372
Name:TRERICE, SUSAN MARY (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:TRERICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N ERIE ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-4403
Mailing Address - Country:US
Mailing Address - Phone:989-233-1555
Mailing Address - Fax:
Practice Address - Street 1:515 ADAMS ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5830
Practice Address - Country:US
Practice Address - Phone:989-894-2991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005522101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional