Provider Demographics
NPI:1508230616
Name:MITTEN, LYNETT C (LADC/MH)
Entity Type:Individual
Prefix:
First Name:LYNETT
Middle Name:C
Last Name:MITTEN
Suffix:
Gender:F
Credentials:LADC/MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 W HIGHWAY 66 APT 2510
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-0029
Mailing Address - Country:US
Mailing Address - Phone:580-374-3304
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 72ND ST STE 234
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5920
Practice Address - Country:US
Practice Address - Phone:580-374-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1460101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional