Provider Demographics
NPI:1275778367
Name:LANCASTER, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:LANCASTER
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 1:31683 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-9634
Mailing Address - Country:US
Mailing Address - Phone:918-658-4788
Mailing Address - Fax:
Practice Address - Street 1:31683 LAKEVIEW LANE
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966
Practice Address - Country:UM
Practice Address - Phone:918-658-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation