Basic Information
| Provider Information | |||||||||
| NPI: | 1649318346 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYMONS | ||||||||
| FirstName: | SUSIE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA LLP LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17320 W 12 MILE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485574003 | ||||||||
| FaxNumber: | 2485574697 | ||||||||
| Practice Location | |||||||||
| Address1: | 17320 W 12 MILE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480762102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485574003 | ||||||||
| FaxNumber: | 2485574697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YM0800X | 6401006382 | MI | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | 6301010121 | MI | X | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.