| Doctor Name: | SUSAN RENAE GROOM |
| NPI Number: | 1306113964 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 201 W Oklahoma Ave Suite 218-219 Guthrie, OK - 730443144 |
| Business Phone Number: | 4052822934 |
| Business Fax Number: | 4052822909 |
| Mailing Address: | 1517 E Roosevelt Ave, GUTHRIE |
| State: | OK |
| Postal Code: | 730446102 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/28/2011 |
| NPI Last Update Date: | 11/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |