=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134425762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN L. MCDANNALD LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2011
-----------------------------------------------------
Last Update Date | 01/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 453 ALLENBY DR
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-8722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-642-0048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 453 ALLENBY DR
-----------------------------------------------------
City | MARYSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43040-8722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-642-0048
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | E100015
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------