Provider Demographics
NPI:1881947422
Name:SUESS CARLIN, JOSEE (CCDC III)
Entity type:Individual
Prefix:
First Name:JOSEE
Middle Name:
Last Name:SUESS CARLIN
Suffix:
Gender:F
Credentials:CCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3429
Mailing Address - Country:US
Mailing Address - Phone:605-718-4870
Mailing Address - Fax:605-718-4878
Practice Address - Street 1:3402 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3429
Practice Address - Country:US
Practice Address - Phone:605-718-4870
Practice Address - Fax:605-718-4878
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD101YA0400X101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5005080Medicaid
SD5005082Medicaid
SD7100744Medicaid
SD5160320Medicaid