Provider Demographics
NPI:1518366590
Name:LANDON, BECKY LYNN
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:LANDON
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 1:237 COUNTY ROAD 1190
Mailing Address - Street 2:
Mailing Address - City:MINCO
Mailing Address - State:OK
Mailing Address - Zip Code:73059-7002
Mailing Address - Country:US
Mailing Address - Phone:405-352-4221
Mailing Address - Fax:
Practice Address - Street 1:428 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6754
Practice Address - Country:US
Practice Address - Phone:405-735-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health