PAUL LYNN SUSIC (NPI# 1790707123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790707123 |
| Entity Type | Individual |
| Full Name | PAUL LYNN SUSIC |
| Credential | MA |
| Practice Address |
2451 Executive Dr. Ste. 103 St. Charles MO 63303 |
| Mailing Address |
350 Trailhead Way Dardenne Prairie MO 63368 |
| Practice Telephone | 6363009922 |
| Mailing Telephone | 6363009922 |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TH0100X |
Psychologist Specialization: Health Service |
01802 | MO | Behavioral Health & Social Service Providers |
| Street Address |
2451 EXECUTIVE DR. STE. 103 |
| City | ST. CHARLES |
| State | MO |
| Zip Code | 63303 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083214787 | Michael Frederick | Pharmacist | 2855 Veterans Memorial Parkway, (pharmacy), Saint Charles, MO 63303 | 2020-10-30 |
| 1710525639 | Cheryl Ann O'dell | Pharmacist | Schnucks Pharmacy, 60 Harvester Square, St Charles, MO 63303 | 2019-12-11 |
| 1255821302 | Melinda R Winfield | Nurse Practitioner | 1313 Park Ct, Saint Charles, MO 63303 | 2018-05-15 |
| 1467904839 | Heather Lilledahl | Speech-Language Pathologist | 2800 Old Muegge Road, Saint Charles, MO 63303 | 2016-11-01 |
| 1437608312 | Preferred Family Healthcare | Counselor | 1559 Old S. River Road, St.charles, MO 63303 | 2016-10-03 |
| 1487109146 | Annette Patricia Davenport | Nurse Practitioner | 1551 Wall Street, Logistics Health Inc, Suite 100, Saint Charles, MO 63303 | 2016-08-23 |
| 1053762328 | Sarah Biondo | Speech-Language Pathologist | 7204 Fountainview Circle, Ofallon, MO 63303 | 2016-06-28 |
| 1710331335 | Lindsey Ann Eilers | Counselor | 1570 South Main, Saint Charles, MO 63303 | 2016-04-20 |
| 1174914600 | Jacquelyn Michele Miller | Pharmacy Technician | 3881 Mexico Road, Saint Charles, MO 63303 | 2015-02-05 |
| 1164838132 | Francelle Denise Neal | Counselor | 2480 Executive Dr Ste 111, Saint Charles, MO 63303 | 2014-07-10 |
| Find all providers in zip 63303 | ||||
| Taxonomy Code | 103TH0100X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Health Service |
| A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974). |
| Notes: Source: National Register of Health Service Providers in Psychology website http://www.nationalregister.org/about_NR.html [7/1/2006: modified title, added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972117240 | Sherri Marie Mccray | Psychologist | 4 Florence Hill Ct, Black Jack, MO 63033-7230 | 2020-09-03 |
| 1740844844 | Shantiela Hall | Psychologist | 1238 Oxford Hill Ct Apt 9, Saint Louis, MO 63146-5721 | 2019-04-24 |
| 1073045340 | Iesha Joseph | Psychologist | 7251 Olive Blvd, Saint Louis, MO 63130-2322 | 2017-03-28 |
| 1346647906 | Emona Lashelle Ewharekuko | Psychologist | 2162 Cherry Ave, Saint Louis, MO 63121-5625 | 2014-11-25 |
| 1164680237 | Rumi Kato Price | Psychologist | Cid Bldg Washington University School of Medicine, Dept of Psychiatry, St Louis, MO 63110 | 2008-05-27 |
| 1083813869 | Kathleen M. Baggett | Psychologist | 5125 Tracy Ave, Kansas City, MO 64110-2515 | 2007-07-12 |
| 1912567322 | Christopher Poitevien | Psychologist | 1 Childrens Pl Ste 3n-14, Saint Louis, MO 63110-1002 | 2019-06-18 |
| 1316458441 | Psych Associates LLC | Psychologist | 1358 E Kingsley St Ste E, Springfield, MO 65804 | 2017-10-16 |
| 1285810432 | New Beginnings Behavioral Health | Psychologist | 729 W Center Cir, Suite 103, Nixa, MO 65714-7001 | 2008-01-18 |
| 1639353915 | Psychological Consultants PC | Psychologist | 6405 N Cosby Ave, Suite 203, Kansas City, MO 64151-2378 | 2007-12-22 |
| Find all providers with the same taxonomy | ||||
| City | ST. CHARLES |
| Zip Code | 63303 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.