Provider Demographics
NPI:1225245046
Name:YOUNGBLOOD, SUSAN RENEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:RENEE
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4001 KNIGHTS BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-1743
Mailing Address - Country:US
Mailing Address - Phone:405-627-0276
Mailing Address - Fax:405-573-0404
Practice Address - Street 1:867 US HIGHWAY 70A
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463-1683
Practice Address - Country:US
Practice Address - Phone:580-668-2337
Practice Address - Fax:405-573-0404
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2006OtherSELECTCARE