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 1:136 N BROADMORE WAY STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5187
Practice Address - Country:US
Practice Address - Phone:571-554-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21349103T00000X, 103TB0200X
IDPSY203136103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral