Provider Demographics
NPI:1861826117
Name:BURTON, SUZANNE (LPC)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-1623
Mailing Address - Country:US
Mailing Address - Phone:208-861-7976
Mailing Address - Fax:
Practice Address - Street 1:3350 W AMERICANA TER
Practice Address - Street 2:SUITE 215
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2521
Practice Address - Country:US
Practice Address - Phone:208-287-9420
Practice Address - Fax:208-287-9426
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional