Provider Demographics
NPI:1346762614
Name:WHITLEY, SUSAN (LPC/MHSP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 GAZEBO PARK DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-3149
Mailing Address - Country:US
Mailing Address - Phone:615-624-6325
Mailing Address - Fax:
Practice Address - Street 1:3720 GAZEBO PARK DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-3149
Practice Address - Country:US
Practice Address - Phone:615-624-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional