Provider Demographics
NPI:1467919258
Name:WATERS, SUZANNE ALAIN
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ALAIN
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 PARKLAWN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4229
Mailing Address - Country:US
Mailing Address - Phone:405-733-5437
Mailing Address - Fax:
Practice Address - Street 1:2801 PARKLAWN DR STE 201
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4229
Practice Address - Country:US
Practice Address - Phone:405-733-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical