Provider Demographics
NPI:1083065973
Name:HOWARD, PAULA LINAE'
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:LINAE'
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 BRANIFF DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-1627
Mailing Address - Country:US
Mailing Address - Phone:405-200-9552
Mailing Address - Fax:
Practice Address - Street 1:5505 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115
Practice Address - Country:US
Practice Address - Phone:405-609-6595
Practice Address - Fax:405-609-6575
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK261QM0801X
103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)