Provider Demographics
NPI:1063804425
Name:DAY, SUSANNAH GRACE (MED, LMHC)
Entity type:Individual
Prefix:MRS
First Name:SUSANNAH
Middle Name:GRACE
Last Name:DAY
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:MS
Other - First Name:SUSANNAH
Other - Middle Name:GRACE
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1950 KEENE RD BLDG G
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7752
Mailing Address - Country:US
Mailing Address - Phone:509-619-0519
Mailing Address - Fax:888-482-2725
Practice Address - Street 1:1950 KEENE RD BLDG G
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7752
Practice Address - Country:US
Practice Address - Phone:509-619-0519
Practice Address - Fax:888-482-2725
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7068101YP2500X
KY171745101YP2500X
WALH60801340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100456950Medicaid