Provider Demographics
NPI:1902240906
Name:SUTTON, CHARLOTTE RENAE
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:RENAE
Last Name:SUTTON
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 1:10512 WHITECHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6962
Mailing Address - Country:US
Mailing Address - Phone:405-229-1895
Mailing Address - Fax:
Practice Address - Street 1:433 W WILSHIRE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7777
Practice Address - Country:US
Practice Address - Phone:405-518-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor