Provider Demographics
NPI:1487425948
Name:GAGE, SUZAN MILLS
Entity type:Individual
Prefix:MRS
First Name:SUZAN
Middle Name:MILLS
Last Name:GAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CHIPLEY
Mailing Address - State:FL
Mailing Address - Zip Code:32428-1428
Mailing Address - Country:US
Mailing Address - Phone:850-693-0808
Mailing Address - Fax:
Practice Address - Street 1:626 5TH ST
Practice Address - Street 2:
Practice Address - City:CHIPLEY
Practice Address - State:FL
Practice Address - Zip Code:32428-1428
Practice Address - Country:US
Practice Address - Phone:850-693-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH25246101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health