Provider Demographics
NPI:1013221951
Name:EDDY, BARBARA SHARON (LPC 2613)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:SHARON
Last Name:EDDY
Suffix:
Gender:F
Credentials:LPC 2613
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 576
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601
Mailing Address - Country:US
Mailing Address - Phone:580-445-6254
Mailing Address - Fax:580-593-2435
Practice Address - Street 1:8877 N 2230 RD
Practice Address - Street 2:
Practice Address - City:CUSTER CITY
Practice Address - State:OK
Practice Address - Zip Code:73639
Practice Address - Country:US
Practice Address - Phone:580-445-6254
Practice Address - Fax:580-593-2435
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 2613101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional