Provider Demographics
NPI:1407979305
Name:SCOTT, SUSAN MILLER (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MILLER
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10914 S ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7264
Mailing Address - Country:US
Mailing Address - Phone:918-296-9216
Mailing Address - Fax:918-296-8343
Practice Address - Street 1:10914 S ERIE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7264
Practice Address - Country:US
Practice Address - Phone:918-296-9216
Practice Address - Fax:918-296-8343
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1020103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical