Basic Information
| Provider Information | |||||||||
| NPI: | 1942502372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINYARD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | GUIDANCE COUNSELOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 959 SOUTH CHIEF AVENUE | ||||||||
| Address2: | |||||||||
| City: | WHITERIVER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283381026 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 959 SOUTH CHIEF AVENUE | ||||||||
| Address2: | |||||||||
| City: | WHITERIVER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283381026 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2010 | ||||||||
| LastUpdateDate: | 11/17/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YS0200X | 27575281 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | School |
No ID Information.