Provider Demographics
NPI:1710225107
Name:EVANS, LINDA SUE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:SUE
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11308 S PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:PERKINS
Mailing Address - State:OK
Mailing Address - Zip Code:74059-4026
Mailing Address - Country:US
Mailing Address - Phone:405-547-5345
Mailing Address - Fax:405-527-4874
Practice Address - Street 1:116 W 7TH AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4064
Practice Address - Country:US
Practice Address - Phone:405-707-9600
Practice Address - Fax:405-707-9601
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1164103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist