Provider Demographics
NPI:1710158191
Name:BINGHAM, LINDA JEWEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JEWEL
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:OK
Mailing Address - Zip Code:74346-0350
Mailing Address - Country:US
Mailing Address - Phone:918-253-4271
Mailing Address - Fax:918-253-4938
Practice Address - Street 1:1015 W WASHBOURNE ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346-4205
Practice Address - Country:US
Practice Address - Phone:918-253-4271
Practice Address - Fax:918-253-4938
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK35841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical