Provider Demographics
NPI:1144887449
Name:BERNDT, SUZANNE (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:BERNDT
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:BERNDT
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4545 N 36TH ST STE 211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3474
Mailing Address - Country:US
Mailing Address - Phone:480-490-6680
Mailing Address - Fax:
Practice Address - Street 1:4545 N 36TH ST STE 211
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3474
Practice Address - Country:US
Practice Address - Phone:480-490-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0015313101YP2500X
AZLPC17681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional