Provider Demographics
NPI:1902615719
Name:MARTIN, SUSIE LEE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSIE
Middle Name:LEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360005
Mailing Address - Street 2:
Mailing Address - City:MONUMENT VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84536-0005
Mailing Address - Country:US
Mailing Address - Phone:435-727-3000
Mailing Address - Fax:435-727-3001
Practice Address - Street 1:30 W MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MONUMENT VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84536-7705
Practice Address - Country:US
Practice Address - Phone:435-727-3000
Practice Address - Fax:435-727-3001
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12476698-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical