Basic Information
| Provider Information | |||||||||
| NPI: | 1558649756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | METCALF | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2541 BELL PORT AVE | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932747408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596799112 | ||||||||
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| Practice Location | |||||||||
| Address1: | 144 S L ST | ||||||||
| Address2: | |||||||||
| City: | DINUBA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936182323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595916680 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2011 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 88004 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.