Healthcare Provider Details

I. General information

NPI: 1245759364
Provider Name (Legal Business Name): SUSAN LYNNE CAHILL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUSAN LYNNE CHERRY NONE

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 08/31/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26428 MC 85
BUCKEYE AZ
85326
US

IV. Provider business mailing address

27183 W ROSS AVE
BUCKEYE AZ
85396-6946
US

V. Phone/Fax

Practice location:
  • Phone: 480-848-4662
  • Fax:
Mailing address:
  • Phone: 307-680-2771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPPC-1031
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPPC-1031
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPPC-1031
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-20196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: