Healthcare Provider Details

I. General information

NPI: 1740064294
Provider Name (Legal Business Name): SUSAN WOOTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 6TH ST
TRAVERSE CITY MI
49684-2345
US

IV. Provider business mailing address

3032 RENNIE ST
TRAVERSE CITY MI
49684-4637
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-5000
  • Fax:
Mailing address:
  • Phone: 231-492-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226076
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberSC0000001230473
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451023083
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: