Provider Demographics
NPI:1750897948
Name:SORRELLS, SUZETTE V (LMHC, QBHP)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:V
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:LMHC, QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1611
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1611
Mailing Address - Country:US
Mailing Address - Phone:219-316-1356
Mailing Address - Fax:
Practice Address - Street 1:1005 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-4262
Practice Address - Country:US
Practice Address - Phone:219-316-1356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN1750897948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor