Provider Demographics
NPI:1902101066
Name:MARION, SUSAN DESANTIS (LPC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:DESANTIS
Last Name:MARION
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 1:1005 EAST MAIN ST.
Mailing Address - Street 2:JACKSON COUNTY MENTAL HEALTH
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504
Mailing Address - Country:US
Mailing Address - Phone:541-774-7890
Mailing Address - Fax:541-774-7981
Practice Address - Street 1:1005 EAST MAIN STREET
Practice Address - Street 2:JACKSON COUNTY MENTAL HEALTH
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504
Practice Address - Country:US
Practice Address - Phone:541-774-7890
Practice Address - Fax:541-774-7981
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1923101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional