Healthcare Provider Details

I. General information

NPI: 1386281681
Provider Name (Legal Business Name): PHILLIP ANTHONY SUESS MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CONRAD ST
RUSHVILLE NE
69360-6503
US

IV. Provider business mailing address

3182 TABLE RD
HAY SPRINGS NE
69347-3112
US

V. Phone/Fax

Practice location:
  • Phone: 402-804-3377
  • Fax:
Mailing address:
  • Phone: 308-360-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12044
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: