Provider Demographics
NPI:1578749701
Name:BURGOYNE, SUZANNE C (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:C
Last Name:BURGOYNE
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 342
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-0060
Mailing Address - Country:US
Mailing Address - Phone:253-750-0150
Mailing Address - Fax:
Practice Address - Street 1:21137 STATE ROUTE 410 E STE D
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-8775
Practice Address - Country:US
Practice Address - Phone:253-750-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF 60261575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist