Provider Demographics
NPI:1295023711
Name:WEST, SUSANNAH MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:MARIE
Last Name:WEST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1818
Mailing Address - Country:US
Mailing Address - Phone:208-878-7008
Mailing Address - Fax:208-878-7009
Practice Address - Street 1:1360 ALBION AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1818
Practice Address - Country:US
Practice Address - Phone:208-878-7008
Practice Address - Fax:208-878-7009
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8146101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1295023711Medicaid