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NPI Code Detail

MEDICARE: AVA GAULT LINDEN M.A LPC, LADC

MEDICARE:   AVA GAULT LINDEN  M.A LPC, LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1720384100
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVA GAULT LINDEN M.A LPC, LADC
Provider Business Mailing Address
First Line : 3525 OAKDALE FOREST RD
Second Line :
City : EDMOND
State : OK
Zip : 73013-7563
Country : US
Telephone Number : 405-740-5465
Fax Number : 405-478-4726
Provider Business Practice Location Address
First Line : 4900 RICHMOND SQ
Second Line : SUITE 102
City : OKLAHOMA CITY
State : OK
Zip : 73118-2028
Country : US
Telephone Number : 405-740-5465
Fax Number : 405-478-4726
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2011
Last Update Date : 02/17/2016

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Directions to “ AVA GAULT LINDEN M.A LPC, LADC” Practice Location

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