Individual
SUSAN ELAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., L.M.F.T.
Contact information
Practice address
LAKE DR., BUILDING 52, MOUNTAIN HOME, TN 37684
(423) 439-8000
(423) 439-2200
Mailing address
PO BOX 699, MOUNTAIN HOME, TN 37684-0699
(423) 439-8000
(423) 439-2200
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
176
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176
STATE LICENSE
TN
Enumeration date
11/28/2006
Last updated
11/02/2010
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