Provider Demographics
NPI:1962594598
Name:NEBEL-SUSSMAN, HOLLI SUE
Entity type:Individual
Prefix:MS
First Name:HOLLI
Middle Name:SUE
Last Name:NEBEL-SUSSMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2802
Mailing Address - Country:US
Mailing Address - Phone:520-512-4456
Mailing Address - Fax:520-512-4494
Practice Address - Street 1:2250 N CRAYCROFT RD
Practice Address - Street 2:SUITE 250
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2802
Practice Address - Country:US
Practice Address - Phone:520-512-4456
Practice Address - Fax:520-512-4494
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ71332OtherAHCCCS