Individual
SUSAN THOMAS MIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., J.D.
Contact information
Practice address
108 ROSEWOOD DR, POTEAU, OK 74953-2232
(918) 658-5438
Mailing address
108 ROSEWOOD DR, POTEAU, OK 74953-2232
(918) 658-5438
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
OK
103TS0200X
School Psychologist
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200226970
—
OK
Enumeration date
10/28/2011
Last updated
10/28/2011
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