Healthcare Provider Details

I. General information

NPI: 1801007505
Provider Name (Legal Business Name): SUSAN KATHLEEN HUART LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4791 NE 2ND TER
FT LAUDERDALE FL
33334-6029
US

IV. Provider business mailing address

4791 NE 2ND TER
FT LAUDERDALE FL
33334-6029
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-6731
  • Fax:
Mailing address:
  • Phone: 954-772-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH2395
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: