Provider Demographics
NPI:1801122734
Name:CROUSE, SUZETTE MARIE (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:MARIE
Last Name:CROUSE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 GABLES DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2085
Mailing Address - Country:US
Mailing Address - Phone:678-576-0322
Mailing Address - Fax:
Practice Address - Street 1:2509 GABLES DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2085
Practice Address - Country:US
Practice Address - Phone:678-576-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 13444235Z00000X
FLMH22258101YM0800X
CA19884235Z00000X
VA2202006526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist