Provider Demographics
NPI:1669706321
Name:HUNTER, SUSAN MAXEEN (LMFT)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MAXEEN
Last Name:HUNTER
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:W4276 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTELLO
Mailing Address - State:WI
Mailing Address - Zip Code:53949-7718
Mailing Address - Country:US
Mailing Address - Phone:608-697-7907
Mailing Address - Fax:
Practice Address - Street 1:W4276 GALE AVE
Practice Address - Street 2:
Practice Address - City:MONTELLO
Practice Address - State:WI
Practice Address - Zip Code:53949-7718
Practice Address - Country:US
Practice Address - Phone:608-697-7907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI843-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist