Provider Demographics
NPI:1902110091
Name:BARGERON, SUE TRANT (PHD)
Entity type:Individual
Prefix:DR
First Name:SUE
Middle Name:TRANT
Last Name:BARGERON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JOYCE
Other - Middle Name:SUE
Other - Last Name:BARGERON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:201 INDEPENDENCE
Mailing Address - Street 2:14TH MEDICAL GROUP
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39710-5300
Mailing Address - Country:US
Mailing Address - Phone:662-434-2239
Mailing Address - Fax:662-434-2110
Practice Address - Street 1:201 INDEPENDENCE
Practice Address - Street 2:14TH MEDICAL GROUP
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39710-5300
Practice Address - Country:US
Practice Address - Phone:662-434-2239
Practice Address - Fax:662-434-2110
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL466103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical