Provider Demographics
NPI:1699971242
Name:LULOW, SUSAN DUBBS (PHD MFT122 MFC13056)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DUBBS
Last Name:LULOW
Suffix:
Gender:F
Credentials:PHD MFT122 MFC13056
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 LEANIHI LN # A105
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5109
Mailing Address - Country:US
Mailing Address - Phone:808-214-4360
Mailing Address - Fax:
Practice Address - Street 1:4 LEANIHI LN # A105
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-5109
Practice Address - Country:US
Practice Address - Phone:808-214-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMFT 122102L00000X, 106H00000X
CAMFC 13056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst