Provider Demographics
NPI:1790014637
Name:PABST, SUE ELLEN (LMSW)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:PABST
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:ELLEN
Other - Last Name:PABST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1504 COMO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-9139
Mailing Address - Country:US
Mailing Address - Phone:616-754-9420
Mailing Address - Fax:616-754-9419
Practice Address - Street 1:507 S. NELSON
Practice Address - Street 2:SUITE A
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-2197
Practice Address - Country:US
Practice Address - Phone:616-754-8545
Practice Address - Fax:616-754-9419
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010852641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical