Provider Demographics
NPI:1467919258
Name:WATERS, SUZANNE ALAIN
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:ALAIN
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 N BROADWAY ST STE E
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5138
Mailing Address - Country:US
Mailing Address - Phone:405-252-0515
Mailing Address - Fax:
Practice Address - Street 1:112 N BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5138
Practice Address - Country:US
Practice Address - Phone:405-252-0515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical