Provider Demographics
NPI:1306143888
Name:SUSAC, PAUL P (LMHC)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:P
Last Name:SUSAC
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W 1ST AVE STE 309
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-6002
Mailing Address - Country:US
Mailing Address - Phone:509-220-1564
Mailing Address - Fax:
Practice Address - Street 1:308 W 1ST AVE STE 309
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-6002
Practice Address - Country:US
Practice Address - Phone:509-220-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00009168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health