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General NPI Number Information
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NPI Number | 1730316407
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Entity Type | Individual
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Provider Name | CARLA D SUITOR M.S. LPC LADC
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Gender | Female
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 1021 E HIGHWAY 66
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City | ELK CITY
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State | OK
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Zip | 73644-1906
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Country | US
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Telephone | 580-225-4337
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Fax | 580-225-4338
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Provider Business Mailing Address
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Address Line | 22678 ROUTE 66 N
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City | CLINTON
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State | OK
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Zip | 73601-7516
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Country | US
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Telephone | 580-225-4337
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Fax | 580-225-4338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 286
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2029
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License Number State | OK
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