Provider Demographics
NPI:1740445303
Name:BARNETT, SUELLEN (MFT)
Entity type:Individual
Prefix:
First Name:SUELLEN
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 QUARRY CT APT 212
Mailing Address - Street 2:
Mailing Address - City:POINT RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-4154
Mailing Address - Country:US
Mailing Address - Phone:707-224-8266
Mailing Address - Fax:707-224-8628
Practice Address - Street 1:1301 QUARRY CT APT 212
Practice Address - Street 2:
Practice Address - City:POINT RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-4154
Practice Address - Country:US
Practice Address - Phone:707-224-8266
Practice Address - Fax:707-224-8628
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist