Provider Demographics
NPI:1417095688
Name:LAWRENCE, SUSAN E (LPC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 CONDOR TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4439
Mailing Address - Country:US
Mailing Address - Phone:405-615-5605
Mailing Address - Fax:
Practice Address - Street 1:301 NW 63RD ST
Practice Address - Street 2:SUITE 600
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7907
Practice Address - Country:US
Practice Address - Phone:405-848-2171
Practice Address - Fax:405-848-2078
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3794101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional