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Organization

PRODIGY FOUNDATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SUSAN HOPE ROBERTS LPC (DIRECTOR)
(918) 456-8399
Entity
Organization

Contact information

Practice address
1024 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4734
(918) 456-8399
(918) 456-8773
Mailing address
PO BOX 1247, TAHLEQUAH, OK 74465-1247
(918) 456-8399
(918) 456-8773

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
101YM0800X
Mental Health Counselor
101YP2500X
Professional Counselor
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
07/21/2006
Last updated
09/11/2025
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