Provider Demographics
NPI:1497451967
Name:SUTHERBY, TONYA LYNN
Entity Type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:LYNN
Last Name:SUTHERBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:691 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2766
Mailing Address - Country:US
Mailing Address - Phone:405-208-4469
Mailing Address - Fax:405-208-4472
Practice Address - Street 1:620 NW 5TH ST STE D
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-3947
Practice Address - Country:US
Practice Address - Phone:405-208-4469
Practice Address - Fax:405-208-4472
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor