Provider Demographics
NPI:1588941678
Name:CHRISTY, SUSAN ALICE
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ALICE
Last Name:CHRISTY
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:PO BOX 1343
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74821-1343
Mailing Address - Country:US
Mailing Address - Phone:580-399-5086
Mailing Address - Fax:
Practice Address - Street 1:1021 S HIGH SCHOOL ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-8231
Practice Address - Country:US
Practice Address - Phone:580-399-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst