Provider Demographics
NPI:1205038841
Name:ESTES, LINDA MARIE (MED, LPC, CM-A)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE
Last Name:ESTES
Suffix:
Gender:F
Credentials:MED, LPC, CM-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6501
Mailing Address - Country:US
Mailing Address - Phone:580-436-2690
Mailing Address - Fax:580-436-5539
Practice Address - Street 1:111 E 12TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-6501
Practice Address - Country:US
Practice Address - Phone:580-436-2690
Practice Address - Fax:580-436-5539
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional