Healthcare Provider Details

I. General information

NPI: 1801122734
Provider Name (Legal Business Name): SUZETTE MARIE CROUSE M.A., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2009
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2509 GABLES DR
EUSTIS FL
32726-2085
US

IV. Provider business mailing address

2509 GABLES DR
EUSTIS FL
32726-2085
US

V. Phone/Fax

Practice location:
  • Phone: 678-576-0322
  • Fax:
Mailing address:
  • Phone: 678-576-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 13444
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: