Provider Demographics
NPI:1578738696
Name:WILLIAMS, SUE ANN (COUNSELOR-)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COUNSELOR-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23755 LINDALE RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-3502
Mailing Address - Country:US
Mailing Address - Phone:918-658-4403
Mailing Address - Fax:
Practice Address - Street 1:23755 LINDALE RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-3502
Practice Address - Country:US
Practice Address - Phone:918-658-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health