Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1284 | AL |
NPI | 1114030590 |
---|---|
Provider Name | Dr. Susan Larae Brandt |
First Address | Huntsville, AL 35801-6495 |
Second Address | Huntsville, AL 35801-6495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 03/04/2012 |