Provider Demographics
NPI:1700940624
Name:SUZOR, SHIRLEY MAY (LMFT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MAY
Last Name:SUZOR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:MAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 N 16TH STREET
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5347
Mailing Address - Country:US
Mailing Address - Phone:602-248-9247
Mailing Address - Fax:602-248-8936
Practice Address - Street 1:4201 N 16TH STREET
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5347
Practice Address - Country:US
Practice Address - Phone:602-248-9247
Practice Address - Fax:602-248-8936
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT0162106H00000X
CAMFC12980106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ739443Medicaid