Healthcare Provider Details

I. General information

NPI: 1912921610
Provider Name (Legal Business Name): SUSAN HOPE ROBERTS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 MAYBERRY DRIVE
TAHLEQUAH OK
74464-4603
US

IV. Provider business mailing address

PO BOX 1247 1140 MAYBERRY DRIVE
TAHLEQUAH OK
74465-1247
US

V. Phone/Fax

Practice location:
  • Phone: 918-456-8399
  • Fax: 918-456-8773
Mailing address:
  • Phone: 918-456-8399
  • Fax: 918-456-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2133
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2133
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: