Provider Demographics
NPI:1982062717
Name:GERALD SUCH MA LPC
Entity Type:Organization
Organization Name:GERALD SUCH MA LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SUCH
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS COUNSELING
Authorized Official - Phone:517-290-5535
Mailing Address - Street 1:3735 CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3917
Mailing Address - Country:US
Mailing Address - Phone:517-290-5535
Mailing Address - Fax:
Practice Address - Street 1:3735 CAVALIER DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3917
Practice Address - Country:US
Practice Address - Phone:517-290-5535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3850984302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization