Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6301017160 | MI |
Y | 103TC0700X | Clinical Psychologist | 6301017160 | MI |
N | 103TS0200X | School Psychologist | SP0000000832633 | MI |
NPI | 1053823583 |
---|---|
Provider Name | Elizabeth Suzanne Sutton |
First Address | Royal Oak, MI 48073-2520 |
Second Address | Troy, MI 48084-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2017 |
Last Update Date | 24/10/2017 |