Provider Demographics
NPI:1780794503
Name:TAKAS, SUZANNE NICOLE (LPCC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:NICOLE
Last Name:TAKAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4568 FRINGE TREE GLN
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-8652
Mailing Address - Country:US
Mailing Address - Phone:513-319-3627
Mailing Address - Fax:
Practice Address - Street 1:4568 FRINGE TREE GLN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8652
Practice Address - Country:US
Practice Address - Phone:513-319-3627
Practice Address - Fax:513-469-6277
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-3858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional