Provider Demographics
NPI:1215169255
Name:DOAN-BEX, SUSAN WHAN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:WHAN
Last Name:DOAN-BEX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 SCR 580
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-5668
Mailing Address - Country:US
Mailing Address - Phone:601-789-5491
Mailing Address - Fax:
Practice Address - Street 1:418 SCR 580
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-5668
Practice Address - Country:US
Practice Address - Phone:601-789-5491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-09
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC21401041C0700X
MSC-2140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117643Medicaid
MS302I804412Medicare PIN