Provider Demographics
NPI:1326188657
Name:STEVENS, SUSAN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-0906
Mailing Address - Country:US
Mailing Address - Phone:208-255-2004
Mailing Address - Fax:
Practice Address - Street 1:212 N 1ST AVE STE G100
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1400
Practice Address - Country:US
Practice Address - Phone:208-255-2004
Practice Address - Fax:208-255-2017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-2843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist