Provider Demographics
NPI:1407955404
Name:TOLBERT, SUSAN ROBINSON (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ROBINSON
Last Name:TOLBERT
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 1:1407 NE D ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462
Mailing Address - Country:US
Mailing Address - Phone:918-967-3368
Mailing Address - Fax:
Practice Address - Street 1:806 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462
Practice Address - Country:US
Practice Address - Phone:918-967-4400
Practice Address - Fax:918-967-4405
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical