Provider Demographics
NPI:1588741763
Name:BROYLES, SUZANNE (LPC)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BROYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2812 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5527
Mailing Address - Country:US
Mailing Address - Phone:918-851-4584
Mailing Address - Fax:
Practice Address - Street 1:4825 S PEORIA AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4558
Practice Address - Country:US
Practice Address - Phone:918-665-0208
Practice Address - Fax:918-665-0216
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1949 LPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional