Provider Demographics
NPI:1487157905
Name:GOLDSTEIN, SUSANNE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:SUSANNE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 W COYOTE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-2352
Mailing Address - Country:US
Mailing Address - Phone:480-771-5400
Mailing Address - Fax:
Practice Address - Street 1:8700 E VISTA BONITA DR STE 138
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4259
Practice Address - Country:US
Practice Address - Phone:480-771-5400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-11
Last Update Date:2018-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health