Provider Demographics
NPI:1922361195
Name:MONTE, SUSAN
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:MONTE
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:DAISY
Mailing Address - State:OK
Mailing Address - Zip Code:74540-0045
Mailing Address - Country:US
Mailing Address - Phone:580-239-1760
Mailing Address - Fax:
Practice Address - Street 1:2405 HWY. 43 EAST
Practice Address - Street 2:
Practice Address - City:DAISY
Practice Address - State:OK
Practice Address - Zip Code:74540-0045
Practice Address - Country:US
Practice Address - Phone:580-239-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor