=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063710838
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TORY D. M. SUEHS MA, LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2011
-----------------------------------------------------
Last Update Date | 10/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 BOWLING LN
-----------------------------------------------------
City | WAUPACA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54981-7707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-931-4745
-----------------------------------------------------
Fax | 920-221-0422
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N5417 COUNTY ROAD B
-----------------------------------------------------
City | MANAWA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54949-8611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-931-4745
-----------------------------------------------------
Fax | 920-221-0422
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 6111-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 6111-125
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------