Provider Demographics
NPI:1508113739
Name:CANUP, SUSAN L (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:CANUP
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 E MAIN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5614
Mailing Address - Country:US
Mailing Address - Phone:580-272-3962
Mailing Address - Fax:
Practice Address - Street 1:730 E MAIN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5614
Practice Address - Country:US
Practice Address - Phone:580-272-3962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-07
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK572101YA0400X
OK2241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)