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Individual

SUSAN KLEENE BARNES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MA, LCPC

Contact information

Practice address
1414 W FRANKLIN ST, BOISE, ID 83702-5023
(208) 343-2730
Mailing address
1414 W FRANKLIN ST, BOISE, ID 83702-5023
(208) 343-2730

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-3722
ID
101YM0800X
Mental Health Counselor
LMFT-4010
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010155402
REGENCE BLUE SHIELD OF ID
ID
01
820516860
NGS AMERICAN INC
ID
01
X6885
BLUE CROSS OF IDAHO
ID
Enumeration date
03/20/2007
Last updated
12/01/2010
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