Provider Demographics
NPI:1528087079
Name:SPENCE, SUZETTE MARIE (MFT)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:MARIE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARRISBURG
Mailing Address - Street 2:IRVINE
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-2620
Mailing Address - Country:US
Mailing Address - Phone:714-801-6850
Mailing Address - Fax:949-387-9106
Practice Address - Street 1:242 W MAIN ST STE 105
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7715
Practice Address - Country:US
Practice Address - Phone:714-801-6850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35422106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist