Active NPI
Kyle Sussenbach
- Marriage & Family Therapist
- Tucker, GA
National Provider Identifier
1033970231
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT001893
- Practice address
- 565 Maribee Dr
Tucker, GA 30084-1714 - Phone
- (678) 534-3824
- NPI assigned
- Jan 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT001893 | GA | Primary |
Addresses
Primary practice location
565 Maribee Dr
Tucker, GA 30084-1714
Mailing address
565 Maribee Dr
Tucker, GA 30084-1714
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 25, 2024 through Apr 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT001893 | GA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705363200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705363200000",
"number": "1033970231",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 MARIBEE DR",
"city": "TUCKER",
"state": "GA",
"postal_code": "300841714"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 MARIBEE DR",
"city": "TUCKER",
"state": "GA",
"postal_code": "300841714",
"telephone_number": "678-534-3824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSSENBACH",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-16",
"last_updated": "2024-01-16",
"certification_date": "2024-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "GA",
"license": "MFT001893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.