Provider Demographics
NPI:1467891754
Name:BARNES NEBEKER, SUSAN NEVADA (LMFTA)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:NEVADA
Last Name:BARNES NEBEKER
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 W NOB HILL BLVD
Mailing Address - Street 2:SUITE 101-157
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7503
Mailing Address - Country:US
Mailing Address - Phone:509-728-7133
Mailing Address - Fax:
Practice Address - Street 1:615 S 48TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4216
Practice Address - Country:US
Practice Address - Phone:509-728-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X
WAMG 60357819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst