Provider Demographics
NPI:1275970220
Name:WARREN, LINDA SUE (MS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:WARREN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41046 E HIGHWAY 31
Mailing Address - Street 2:
Mailing Address - City:MCCURTAIN
Mailing Address - State:OK
Mailing Address - Zip Code:74944-3269
Mailing Address - Country:US
Mailing Address - Phone:918-945-7365
Mailing Address - Fax:918-945-7500
Practice Address - Street 1:41046 E HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:MCCURTAIN
Practice Address - State:OK
Practice Address - Zip Code:74944-3269
Practice Address - Country:US
Practice Address - Phone:918-945-7365
Practice Address - Fax:918-945-7500
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332101YA0400X
OK2849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)