Basic Information
| Provider Information | |||||||||
| NPI: | 1902110091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARGERON | ||||||||
| FirstName: | SUE | ||||||||
| MiddleName: | TRANT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BARGERON | ||||||||
| OtherFirstName: | JOYCE | ||||||||
| OtherMiddleName: | SUE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 201 INDEPENDENCE | ||||||||
| Address2: | 14TH MEDICAL GROUP | ||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397105300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624342239 | ||||||||
| FaxNumber: | 6624342110 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 INDEPENDENCE | ||||||||
| Address2: | 14TH MEDICAL GROUP | ||||||||
| City: | COLUMBUS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 397105300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624342239 | ||||||||
| FaxNumber: | 6624342110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2010 | ||||||||
| LastUpdateDate: | 12/05/2012 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 466 | AL | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.