Provider Demographics
NPI:1184153017
Name:EARNST, SUSAN LEIGH (LCPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEIGH
Last Name:EARNST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 S ORCHARD ST STE B
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-6722
Mailing Address - Country:US
Mailing Address - Phone:208-996-3879
Mailing Address - Fax:208-473-7272
Practice Address - Street 1:2300 S ORCHARD ST STE B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-6722
Practice Address - Country:US
Practice Address - Phone:208-996-3879
Practice Address - Fax:208-473-7272
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7794101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health