Provider Demographics
NPI:1932404621
Name:SUH, RA Y (LCSW)
Entity Type:Individual
Prefix:
First Name:RA
Middle Name:Y
Last Name:SUH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 E SUMMER SET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-9776
Mailing Address - Country:US
Mailing Address - Phone:417-719-0973
Mailing Address - Fax:
Practice Address - Street 1:1944 E SUNSHINE ST STE D
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1510
Practice Address - Country:US
Practice Address - Phone:417-413-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2024-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200379231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical