| Doctor Name: | PAUL LYNN SUSIC |
| NPI Number: | 1790707123 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MA |
| License Number: | 01802 |
| Business Practice Address: | 2451 Executive Dr. Ste. 103 St. Charles, MO - 63303 |
| Business Phone Number: | 6363009922 |
| Business Fax Number: | |
| Mailing Address: | 350 Trailhead Way, DARDENNE PRAIRIE |
| State: | MO |
| Postal Code: | 63368 |
| Phone Number: | 6363009922 |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TH0100X |
| License Number: | 01802 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |