Provider Demographics
NPI:1164817136
Name:STORM, SUZANNA LYDIA (MS)
Entity Type:Individual
Prefix:
First Name:SUZANNA
Middle Name:LYDIA
Last Name:STORM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SUZANNA
Other - Middle Name:
Other - Last Name:SAWYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:650 S PEORIA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-4429
Mailing Address - Country:US
Mailing Address - Phone:918-587-9471
Mailing Address - Fax:918-560-1399
Practice Address - Street 1:11740 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1820
Practice Address - Country:US
Practice Address - Phone:918-437-9495
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor