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General NPI Number Information
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NPI Number | 1255680823
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Entity Type | Organization
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Legal Business Name | COUNSELING SERVICES OF YUKON ,LLC
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 09/06/2012
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Provider Practice Location Address
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Address Line | 110 S. 5TH ST SUITE 200
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City | YUKON
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State | OK
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Zip | 73099-2601
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Country | US
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Telephone | 405-354-5020
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Fax | 405-354-5022
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Provider Business Mailing Address
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Address Line | 110 S. 5TH ST SUITE 200
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City | YUKON
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State | OK
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Zip | 73099-2601
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Country | US
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Telephone | 405-354-5020
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Fax | 405-354-5022
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. LINDA KAY FARLOW-WHITTENBERG
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Credential | PH.D. PSYCHOLOGIST
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Telephone | 405-354-5020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 698
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License Number State | OK
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