Basic Information
| Provider Information | |||||||||
| NPI: | 1891095485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYHRS | ||||||||
| FirstName: | SUSANNE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2550 S TELEGRAPH RD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BLOOMFIELD HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483020950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483220001 | ||||||||
| FaxNumber: | 2483220004 | ||||||||
| Practice Location | |||||||||
| Address1: | 10785 S SAGINAW ST | ||||||||
| Address2: | SUITE A, BUILDING E | ||||||||
| City: | GRAND BLANC | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484397003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106950055 | ||||||||
| FaxNumber: | 8106956813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2010 | ||||||||
| LastUpdateDate: | 11/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801070806 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.