Individual
SUSAN LEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYCHOLOGIST
Contact information
Practice address
VIA TELEHEALTH, OWENSBORO, KY 42301
(270) 302-2600
(229) 491-9038
Mailing address
708 FULLERTON AVENUE, LEIGHIGH ACRES, FL 33974
(270) 302-2600
(239) 491-9038
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
KY 1333
KY
106H00000X
Marriage & Family Therapist
KY0504
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000551121
ANTHEM BLUE CROSS
—
Enumeration date
05/31/2006
Last updated
09/08/2015
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