Provider Demographics
NPI:1184012452
Name:JORDAN, LINDA CAROL
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:CAROL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 109
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-0109
Mailing Address - Country:US
Mailing Address - Phone:918-650-3051
Mailing Address - Fax:918-650-9720
Practice Address - Street 1:316 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-4240
Practice Address - Country:US
Practice Address - Phone:918-650-9292
Practice Address - Fax:918-650-9720
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)