Provider Information for 1821389560
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Miss SUSAN LYNN MAXFIELD MS, LMFT
Sex: Female
NPI: 1821389560
Last Updated: 2019-04-30
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1821389560 | ||||||||
| Enumeration Date | 2011-04-28 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1727 MALVASIA AVE TULARE, CA 93274-7843 United States Phone: 559-750-7518 | Fax:559-686-7920 | ||||||||
| Primary Practice Address | 1029 N DEMAREE ST VISALIA, CA 93291-4117 United States Phone: 559-750-7518 | Fax: | ||||||||
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