Provider Demographics
NPI:1962671578
Name:FOOTE, SUSAN LUELLIA (DPO 11)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LUELLIA
Last Name:FOOTE
Suffix:
Gender:F
Credentials:DPO 11
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4535
Mailing Address - Country:US
Mailing Address - Phone:905-781-5300
Mailing Address - Fax:805-781-1231
Practice Address - Street 1:2176 JOHNSON AVE
Practice Address - Street 2:PROBATION
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:905-781-5300
Practice Address - Fax:805-781-1231
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor