Provider Demographics
NPI:1740471192
Name:BARRETT, SUSAN CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 E MAIN STREET PMB 218
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1933
Mailing Address - Country:US
Mailing Address - Phone:208-329-6647
Mailing Address - Fax:
Practice Address - Street 1:309 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PAUL
Practice Address - State:ID
Practice Address - Zip Code:83347
Practice Address - Country:US
Practice Address - Phone:208-329-6647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY203136103TB0200X, 103TC0700X
CAPSY21349103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral