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NPI Code Detail

MEDICARE: SUZANNE BROYLES L.P.C.

MEDICARE: SUZANNE BROYLES L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor1949 LPCOK

General Provider Information

NPI Number : 1588741763
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUZANNE BROYLES L.P.C.
Provider Business Mailing Address
First Line : 2812 E 71ST ST
Second Line :
City : TULSA
State : OK
Zip : 74136-5527
Country : US
Telephone Number : 918-851-4584
Fax Number :
Provider Business Practice Location Address
First Line : 4825 S PEORIA AVE
Second Line : SUITE 7
City : TULSA
State : OK
Zip : 74105-4558
Country : US
Telephone Number : 918-665-0208
Fax Number : 918-665-0216
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 07/08/2007

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Directions to “ SUZANNE BROYLES L.P.C.” Practice Location

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