Provider Demographics
NPI:1578196986
Name:KRIDER, SUSAN BLAKE (LMHCA)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BLAKE
Last Name:KRIDER
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6306
Mailing Address - Country:US
Mailing Address - Phone:812-372-1571
Mailing Address - Fax:
Practice Address - Street 1:927 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6824
Practice Address - Country:US
Practice Address - Phone:812-372-1571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health