Healthcare Provider Details

I. General information

NPI: 1649388752
Provider Name (Legal Business Name): SUSAN D ADOLPH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN D. MCMAHON LPC

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 ANTELOPE MEADOWS DR
BURNS WY
82053-9130
US

IV. Provider business mailing address

3953 ANTELOPE MEADOWS DR
BURNS WY
82053-9130
US

V. Phone/Fax

Practice location:
  • Phone: 307-286-3909
  • Fax:
Mailing address:
  • Phone: 307-286-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-907
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4561
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0003340
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: