Provider Demographics
NPI:1356476667
Name:LINDBLAD-LANDLER, JACKIE JEAN (LPC LADC)
Entity Type:Individual
Prefix:MS
First Name:JACKIE
Middle Name:JEAN
Last Name:LINDBLAD-LANDLER
Suffix:
Gender:F
Credentials:LPC LADC
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:LINDBLAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5228 CLASSEN CIRCLE
Mailing Address - Street 2:A CHANCE TO CHANGE
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-840-9000
Mailing Address - Fax:405-840-9017
Practice Address - Street 1:5228 CLASSEN CIRCLE
Practice Address - Street 2:A CHANCE TO CHANGE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-840-9000
Practice Address - Fax:405-840-9017
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK282101YA0400X
OK2634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional