Provider Demographics
NPI:1487811535
Name:FUX CORTES, SUSANNE KARENINA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:KARENINA
Last Name:FUX CORTES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 TELEGRAPH CANYON RD
Mailing Address - Street 2:201
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910
Mailing Address - Country:US
Mailing Address - Phone:619-787-0682
Mailing Address - Fax:
Practice Address - Street 1:680 TELEGRAPH CANYON RD
Practice Address - Street 2:202
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910
Practice Address - Country:US
Practice Address - Phone:619-787-0682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 47477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist