Healthcare Provider Details

I. General information

NPI: 1356671663
Provider Name (Legal Business Name): SUSAN KELLI PIPES MS LPC CAND.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 PARK ST SE TRLR 10A
ARDMORE OK
73401-8369
US

IV. Provider business mailing address

602 PARK ST SE TRLR 10A
ARDMORE OK
73401-8369
US

V. Phone/Fax

Practice location:
  • Phone: 580-222-5705
  • Fax:
Mailing address:
  • Phone: 580-222-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: