Provider Demographics
NPI:1730432444
Name:HEALEY HARRIS, SUSAN ALEXANDRA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALEXANDRA
Last Name:HEALEY HARRIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:ALEXANDRA
Other - Last Name:HEALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7217 WESTHAMPTON PL
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-7451
Mailing Address - Country:US
Mailing Address - Phone:865-223-2932
Mailing Address - Fax:
Practice Address - Street 1:305 WESTFIELD DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4824
Practice Address - Country:US
Practice Address - Phone:865-584-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional