Healthcare Provider Details

I. General information

NPI: 1205038841
Provider Name (Legal Business Name): LINDA MARIE ESTES M.ED., LPC, CM-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 12TH ST
ADA OK
74820-6501
US

IV. Provider business mailing address

111 E 12TH ST
ADA OK
74820-6501
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-2690
  • Fax: 580-436-5539
Mailing address:
  • Phone: 580-436-2690
  • Fax: 580-436-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3535
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: