Individual
SUSAN CHACKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12000 N VIRGINIA AVENUE, OKLAHOMA CITY, OK 73120
(405) 835-6757
Mailing address
2714 LAMOND HILL AVE, EDMOND, OK 73034-6979
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/22/2017
Last updated
08/22/2017
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