Basic Information
Provider Information
NPI: 1316154230
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BREYMEYER
FirstName: SUSAN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: LMHC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8400 LOUISIANA ST
Address2:  
City: MERRILLVILLE
State: IN
PostalCode: 464106385
CountryCode: US
TelephoneNumber: 2197571932
FaxNumber: 2197571950
Practice Location
Address1: 8555 TAFT ST
Address2:  
City: MERRILLVILLE
State: IN
PostalCode: 464106123
CountryCode: US
TelephoneNumber: 2197694005
FaxNumber: 2197692508
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 05/25/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X39001691AINY Behavioral Health & Social Service ProvidersCounselorMental Health

ID Information
IDTypeStateIssuerDescription
00000037415301INANTHEMOTHER


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