Provider Demographics
NPI:1699861542
Name:VOIGT, SUSAN LEE (MA ATR BC LPAT LPCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEE
Last Name:VOIGT
Suffix:
Gender:F
Credentials:MA ATR BC LPAT LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 1ST
Mailing Address - Street 2:STE 532
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203
Mailing Address - Country:US
Mailing Address - Phone:505-627-0439
Mailing Address - Fax:505-622-2750
Practice Address - Street 1:200 W 1ST
Practice Address - Street 2:STE 532
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203
Practice Address - Country:US
Practice Address - Phone:505-627-0439
Practice Address - Fax:505-622-2750
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2756221700000X
IL99003221700000X
NM0085801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM202636OtherVALUE OPTIONS MEDICAID