Provider Demographics
NPI:1972089274
Name:HART, SUSAN COREY (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:COREY
Last Name:HART
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 S OLD HIGHWAY 94 STE 234
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5612
Mailing Address - Country:US
Mailing Address - Phone:636-284-6082
Mailing Address - Fax:
Practice Address - Street 1:2536 S OLD HIGHWAY 94 STE 234
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:636-284-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024648101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional