| Doctor Name: | MS. SUZANNA JOLENE WATERS |
| NPI Number: | 1275965881 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.P.C |
| License Number: | LPC-5306 |
| Business Practice Address: | 115 W Idaho St Weiser, ID - 836721945 |
| Business Phone Number: | 2085490330 |
| Business Fax Number: | |
| Mailing Address: | 6099 S Teton Peak Way, BOISE |
| State: | ID |
| Postal Code: | 837167026 |
| Phone Number: | 2085490330 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2013 |
| NPI Last Update Date: | 08/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LPC-5306 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |