Provider Demographics
NPI:1356451645
Name:KENT, SUSAN MORGART (LCSW, LADC)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MORGART
Last Name:KENT
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:MORGART
Other - Last Name:CHASTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LADC
Mailing Address - Street 1:34812 E 241ST ST S
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:OK
Mailing Address - Zip Code:74454-5881
Mailing Address - Country:US
Mailing Address - Phone:918-352-1685
Mailing Address - Fax:
Practice Address - Street 1:37353 E 221ST ST S
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:OK
Practice Address - Zip Code:74454-5615
Practice Address - Country:US
Practice Address - Phone:918-352-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK37891041C0700X
OK622101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK46051-7687Medicare UPIN
OK248321401Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER