Provider Demographics
NPI:1831498732
Name:NEAL, SUSANNE BRIDGETTE (LPC, CACIII, MAC)
Entity type:Individual
Prefix:MS
First Name:SUSANNE
Middle Name:BRIDGETTE
Last Name:NEAL
Suffix:
Gender:F
Credentials:LPC, CACIII, MAC
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 759
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-0759
Mailing Address - Country:US
Mailing Address - Phone:197-293-0750
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 759
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-0759
Practice Address - Country:US
Practice Address - Phone:719-293-0750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-18
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014244101YP2500X
CO20802101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional