Basic Information
| Provider Information | |||||||||
| NPI: | 1285605717 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM BURCHETTE | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 821350 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606875221 | ||||||||
| FaxNumber: | 3606660466 | ||||||||
| Practice Location | |||||||||
| Address1: | 3400 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606965016 | ||||||||
| FaxNumber: | 3606965032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 07/07/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LH0005815 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.