Provider Demographics
NPI:1720384100
Name:LINDEN, AVA GAULT (MA LPC, LADC)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:GAULT
Last Name:LINDEN
Suffix:
Gender:F
Credentials:MA LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 OAKDALE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-7563
Mailing Address - Country:US
Mailing Address - Phone:405-740-5465
Mailing Address - Fax:405-478-4726
Practice Address - Street 1:4900 RICHMOND SQ
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2028
Practice Address - Country:US
Practice Address - Phone:405-740-5465
Practice Address - Fax:405-478-4726
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)