Provider Demographics
NPI:1134281231
Name:BOYER, SUSAN E (LMFT CEAP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:BOYER
Suffix:
Gender:F
Credentials:LMFT CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4445 W 77TH ST STE 234
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5146
Mailing Address - Country:US
Mailing Address - Phone:952-945-9179
Mailing Address - Fax:952-835-1995
Practice Address - Street 1:4445 W 77TH ST STE 234
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5146
Practice Address - Country:US
Practice Address - Phone:952-945-9179
Practice Address - Fax:952-835-1995
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN670190600Medicaid