Provider Demographics
NPI:1649416520
Name:LINCICOME, TOPPIE (MED)
Entity Type:Individual
Prefix:MR
First Name:TOPPIE
Middle Name:
Last Name:LINCICOME
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2252 GRAY DOVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-2359
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2252 GRAY DOVE
Practice Address - Street 2:CITIZEN POTAWATOMI NATION CLINIC 2307 S. GORDON COOPER
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2359
Practice Address - Country:US
Practice Address - Phone:405-517-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-26
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2144101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional