Provider Demographics
NPI:1962644112
Name:BRYAN, SUZETTE PAIGE (MAC, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:PAIGE
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MAC, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 W HANKS TRL
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-7601
Mailing Address - Country:US
Mailing Address - Phone:580-254-5322
Mailing Address - Fax:
Practice Address - Street 1:1213 W HANKS TRL
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-7601
Practice Address - Country:US
Practice Address - Phone:580-254-5322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional