Provider Demographics
NPI:1841876281
Name:ALBERTS, SUSAN (EDS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ALBERTS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SILVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2002
Mailing Address - Country:US
Mailing Address - Phone:405-760-3184
Mailing Address - Fax:
Practice Address - Street 1:1020 SILVER OAKS DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025-2002
Practice Address - Country:US
Practice Address - Phone:405-760-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2200101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor