Provider Demographics
NPI:1154880912
Name:O'LEARY, SUSAN CHRISTINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 LEON YOUNG DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-2028
Mailing Address - Country:US
Mailing Address - Phone:760-805-7384
Mailing Address - Fax:
Practice Address - Street 1:5621 LEON YOUNG DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-2028
Practice Address - Country:US
Practice Address - Phone:760-805-7384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-19
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health