1538589130 NPI number — MRS. SUSAN C. CURRENT LMSW

Table of content: MRS. SUSAN C. CURRENT LMSW (NPI 1538589130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538589130 NPI number — MRS. SUSAN C. CURRENT LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURRENT
Provider First Name:
SUSAN
Provider Middle Name:
C.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORRISON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
C.
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1538589130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3407 SHAMROCK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAUTIER
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39553-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3407 SHAMROCK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAUTIER
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39553-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-497-0690
Provider Business Practice Location Address Fax Number:
228-497-1363
Provider Enumeration Date:
04/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00018214 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: GUUAN4253687 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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