Provider Demographics
NPI:1285904797
Name:OUTSON, SUSAN L (MA, LMHP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:OUTSON
Suffix:
Gender:F
Credentials:MA, LMHP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHP
Mailing Address - Street 1:5841 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4026
Mailing Address - Country:US
Mailing Address - Phone:402-483-6372
Mailing Address - Fax:
Practice Address - Street 1:5841 MEADOWBROOK LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4026
Practice Address - Country:US
Practice Address - Phone:402-483-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health