Provider Demographics
NPI:1982736930
Name:WINGFIELD, SUSAN HELMS
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:HELMS
Last Name:WINGFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:HELMS
Other - Last Name:WHICKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 SE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-8387
Mailing Address - Country:US
Mailing Address - Phone:405-735-3381
Mailing Address - Fax:
Practice Address - Street 1:2600 SE 5TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-8387
Practice Address - Country:US
Practice Address - Phone:405-735-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0959103TB0200X, 103TF0000X, 103TH0100X, 103T00000X, 103TP2701X, 103TR0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical