Provider Demographics
NPI:1396947305
Name:HEUSTIS, ROBERTA SUE (LADC, (US))
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:SUE
Last Name:HEUSTIS
Suffix:
Gender:F
Credentials:LADC, (US)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18921 W WEKIWA RD LOT 31
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-5970
Mailing Address - Country:US
Mailing Address - Phone:918-981-0833
Mailing Address - Fax:
Practice Address - Street 1:2727 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74110-5436
Practice Address - Country:US
Practice Address - Phone:918-835-3017
Practice Address - Fax:918-836-0358
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)