Individual
MRS. SUSAN LOUISE BROCKLESBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
10950 S 143RD ST E, MULVANE, KS 67110-9451
(316) 409-4782
Mailing address
10950 S 143RD ST E, MULVANE, KS 67110-9451
(316) 409-4782
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7572
KS
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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