Doctor Name: | SUSAN TODD |
NPI Number: | 1417114372 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 002502 |
Business Practice Address: | Rr 1 Box 108 Malta Bend, MO - 653399719 |
Business Phone Number: | 6605952318 |
Business Fax Number: | |
Mailing Address: | Rr 1 Box 108, MALTA BEND |
State: | MO |
Postal Code: | 653399719 |
Phone Number: | 6605952318 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2008 |
NPI Last Update Date: | 05/19/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 002502 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |