Provider Demographics
NPI:1932390812
Name:JORDAN, SUSAN ELIZABETH (MA, LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIZABETH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:ELIZABETH
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:2500 S BROADWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4038
Mailing Address - Country:US
Mailing Address - Phone:405-314-8463
Mailing Address - Fax:
Practice Address - Street 1:2500 S BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4038
Practice Address - Country:US
Practice Address - Phone:405-314-8463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional