Provider Demographics
NPI:1588951651
Name:DAWSON, SUE ELLEN (MA, PLPC)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:ELLEN
Last Name:DAWSON
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-1650
Mailing Address - Country:US
Mailing Address - Phone:417-396-9166
Mailing Address - Fax:
Practice Address - Street 1:302 S FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1650
Practice Address - Country:US
Practice Address - Phone:417-396-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5987101YA0400X
MO2011008998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)