1174691950 NPI number — MS. DEBRA SUSKIN GION LPC

Table of content: MS. DEBRA SUSKIN GION LPC (NPI 1174691950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174691950 NPI number — MS. DEBRA SUSKIN GION LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GION
Provider First Name:
DEBRA
Provider Middle Name:
SUSKIN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINGO
Provider Other First Name:
DEBRA
Provider Other Middle Name:
SUSKIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174691950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12706
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-0046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-858-6262
Provider Business Mailing Address Fax Number:
480-839-0197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21300 N JOHN WAYNE PKWY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MARICOPA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85139-8979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-858-6262
Provider Business Practice Location Address Fax Number:
480-839-0197
Provider Enumeration Date:
12/01/2006

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: 101YP2500X , with the licence number:  LPC-#0277 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 931081 . This is a "AHCCCS PROVIDER ID" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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