Provider Demographics
NPI:1427460948
Name:FLACK, SUSAN (LMHC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FLACK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:CHALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6409 54TH ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-6649
Mailing Address - Country:US
Mailing Address - Phone:206-696-3365
Mailing Address - Fax:
Practice Address - Street 1:2711 N 21ST ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-7519
Practice Address - Country:US
Practice Address - Phone:206-422-0940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
WALH60980741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst