Provider Demographics
NPI:1396136594
Name:VILLEGAS, SUSY P (PHD, LCSW)
Entity type:Individual
Prefix:
First Name:SUSY
Middle Name:P
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:SUSY
Other - Middle Name:P
Other - Last Name:VILLEGAS DE CHAVERRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-5610
Mailing Address - Country:US
Mailing Address - Phone:405-236-0701
Mailing Address - Fax:
Practice Address - Street 1:420 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-5610
Practice Address - Country:US
Practice Address - Phone:405-236-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical