Provider Demographics
NPI:1497171151
Name:BARNES, SUZANNE H (LMFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:H
Last Name:BARNES
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 1:523 STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2736
Mailing Address - Country:US
Mailing Address - Phone:541-301-6714
Mailing Address - Fax:
Practice Address - Street 1:310 E 6TH ST
Practice Address - Street 2:ROOM 200 & 202
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-5933
Practice Address - Country:US
Practice Address - Phone:541-301-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2017-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0929106H00000X
CAMFC25312106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500684288Medicaid
OR530811OtherMHN PROVIDER ID
OR60054OtherAETNA PROVIDER ID