MEDICARE: DR. SUSAN FRISSELL PH.D., LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCPC 180-001112	IL

General Provider Information

NPI Number	:	1134298326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN FRISSELL PH.D., LCPC

Provider Business Mailing Address
First Line	:	4550 CENTRAL AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1825
Country	:	US
Telephone Number	:	847-224-7506
Fax Number	:	317-929-1161

Provider Business Practice Location Address
First Line	:	4550 CENTRAL AVE STE 201F
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1825
Country	:	US
Telephone Number	:	847-224-7506
Fax Number	:	317-929-1161

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	01/17/2019

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