Provider Demographics
NPI:1922656578
Name:MAYER, SUSAN LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:MAYER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17605 E IDLE DR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7522
Mailing Address - Country:US
Mailing Address - Phone:916-794-3483
Mailing Address - Fax:
Practice Address - Street 1:137 E ARCTIC AVE STE 2A
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6255
Practice Address - Country:US
Practice Address - Phone:916-794-3483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK796OtherPROFESSIONAL LICENSE NUMBER