Provider Demographics
NPI:1871052134
Name:SUCHANIC, JOSEPH BRENT (MA,LIMHP, LMFT, LCPC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRENT
Last Name:SUCHANIC
Suffix:
Gender:M
Credentials:MA,LIMHP, LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11014 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3223
Mailing Address - Country:US
Mailing Address - Phone:406-304-6620
Mailing Address - Fax:
Practice Address - Street 1:12110 PORT GRACE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3190
Practice Address - Country:US
Practice Address - Phone:402-630-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-17
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40038101YP2500X
NE3647101YM0800X
MTBBH-PCLC-LIC-32427M101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional