Basic Information
| Provider Information | |||||||||
| NPI: | 1104176858 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORRES | ||||||||
| FirstName: | SUSANNAH | ||||||||
| MiddleName: | RANDLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4092 MEMORIAL PKWY SW | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568822457 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4092 MEMORIAL PKWY SW | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358024365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568822457 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2012 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 0-12-4989 | AL | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.