Provider Demographics
NPI:1871567891
Name:STRONG, SUSAN K (MED, LPC, LISAC, NCC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:STRONG
Suffix:
Gender:F
Credentials:MED, LPC, LISAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26033
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86312-6033
Mailing Address - Country:US
Mailing Address - Phone:928-445-0055
Mailing Address - Fax:
Practice Address - Street 1:8591 E FLORENTINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8947
Practice Address - Country:US
Practice Address - Phone:928-445-0055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12938101YP2500X
AZLISAC-11532101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)