Provider Demographics
NPI:1982352043
Name:JUVELIER, SUSAN ANN (LPC LAT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:JUVELIER
Suffix:
Gender:F
Credentials:LPC LAT
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 1933
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-1933
Mailing Address - Country:US
Mailing Address - Phone:307-733-8535
Mailing Address - Fax:
Practice Address - Street 1:1215 W ANGUS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9240
Practice Address - Country:US
Practice Address - Phone:307-733-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-252101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health