Provider Demographics
NPI:1750591285
Name:RASSAS, SUSAN R (LPC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:R
Last Name:RASSAS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:S R
Other - Middle Name:RASSAS
Other - Last Name:COUNSELING LLC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85636-0845
Mailing Address - Country:US
Mailing Address - Phone:520-459-2039
Mailing Address - Fax:520-458-2045
Practice Address - Street 1:451 BARTOW DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-1838
Practice Address - Country:US
Practice Address - Phone:520-459-2039
Practice Address - Fax:520-458-2045
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 2288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health