Provider Demographics
NPI:1982591756
Name:FENICH, SUSAN BALTICH (LMHC)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BALTICH
Last Name:FENICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 COMMERCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6880
Mailing Address - Country:US
Mailing Address - Phone:863-701-7373
Mailing Address - Fax:
Practice Address - Street 1:2330 COMMERCE POINT DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6880
Practice Address - Country:US
Practice Address - Phone:863-221-9494
Practice Address - Fax:863-606-1499
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24276101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health