Provider Demographics
NPI:1063716017
Name:HUMBERT, SUZANNE ELLEN (MHRS, LPC-C)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ELLEN
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:MHRS, LPC-C
Other - Prefix:
Other - First Name:SUZI
Other - Middle Name:ELLEN
Other - Last Name:HUMBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:290 PIONEER ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-2133
Mailing Address - Country:US
Mailing Address - Phone:831-459-6644
Mailing Address - Fax:
Practice Address - Street 1:1008 DEPOT HILL RD
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6723
Practice Address - Country:US
Practice Address - Phone:303-909-0116
Practice Address - Fax:720-358-0846
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
COLPCC0022759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44POtherRSS/CSSOP