Individual
MR. KYLE CARTER SUSSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11600 ELDRIDGE AVE, LAKE VIEW TERRACE, CA 91342-6506
(818) 686-3261
Mailing address
11600 ELDRIDGE AVE, LAKE VIEW TERRACE, CA 91342-6506
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
11972
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/27/2021
Last updated
09/29/2023
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