Provider Demographics
NPI:1700817459
Name:VAN VALKENBURG, LINDA KAYE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:KAYE
Last Name:VAN VALKENBURG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2431 E 61ST ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1263
Mailing Address - Country:US
Mailing Address - Phone:918-749-5007
Mailing Address - Fax:918-747-7911
Practice Address - Street 1:2431 E 61ST ST
Practice Address - Street 2:SUITE 225
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1263
Practice Address - Country:US
Practice Address - Phone:918-749-5007
Practice Address - Fax:918-747-7911
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1140101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1140OtherLPC