Provider Demographics
NPI:1720167406
Name:BURIC, SUSAN (MA LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BURIC
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193B PINEVIEW DR
Mailing Address - Street 2:MORGANTOWN MENTAL HEALTH ASSOCIATES LLC
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-599-1816
Mailing Address - Fax:304-599-1459
Practice Address - Street 1:1193B PINEVIEW DR
Practice Address - Street 2:MORGANTOWN MENTAL HEALTH ASSOCIATES LLC
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-599-1816
Practice Address - Fax:304-599-1459
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0116779000Medicaid
WV0799125Medicare PIN