Provider Demographics
NPI:1730365115
Name:YOO, SUSIE S (MFT)
Entity type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:S
Last Name:YOO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24260 CRENSHAW BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5303
Mailing Address - Country:US
Mailing Address - Phone:310-430-9199
Mailing Address - Fax:310-326-5507
Practice Address - Street 1:24260 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5303
Practice Address - Country:US
Practice Address - Phone:310-430-9199
Practice Address - Fax:310-326-5507
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC44702106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist