Provider Demographics
NPI:1902343924
Name:FELICE, SUSAN CLARK (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLARK
Last Name:FELICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:FELICE
Other - Last Name:HOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 LAMBKIN WAY
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2902
Mailing Address - Country:US
Mailing Address - Phone:970-556-8559
Mailing Address - Fax:
Practice Address - Street 1:3400 LAMBKIN WAY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2902
Practice Address - Country:US
Practice Address - Phone:970-556-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2024-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO244552081041S0200X
COCSW.099294181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool