Provider Demographics
NPI:1386281681
Name:SUESS, PHILLIP ANTHONY (MA)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:SUESS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3182 TABLE RD
Mailing Address - Street 2:
Mailing Address - City:HAY SPRINGS
Mailing Address - State:NE
Mailing Address - Zip Code:69347-3112
Mailing Address - Country:US
Mailing Address - Phone:308-360-3606
Mailing Address - Fax:
Practice Address - Street 1:307 CONRAD ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NE
Practice Address - Zip Code:69360-6503
Practice Address - Country:US
Practice Address - Phone:402-804-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health