Provider Demographics
NPI:1699224188
Name:COBURN, SUSAN DEANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:DEANN
Last Name:COBURN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 OAK HERITAGE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2782
Mailing Address - Country:US
Mailing Address - Phone:405-596-9277
Mailing Address - Fax:
Practice Address - Street 1:6424 OAK HERITAGE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-2782
Practice Address - Country:US
Practice Address - Phone:405-596-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health