Provider Demographics
NPI:1760713721
Name:ZINNIKAS, CECILIA GAYE (LPC OK#2869)
Entity Type:Individual
Prefix:MRS
First Name:CECILIA
Middle Name:GAYE
Last Name:ZINNIKAS
Suffix:
Gender:F
Credentials:LPC OK#2869
Other - Prefix:MS
Other - First Name:CECILIA
Other - Middle Name:GAYE
Other - Last Name:DIETZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC OK#2869
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:OK
Mailing Address - Zip Code:74350-0485
Mailing Address - Country:US
Mailing Address - Phone:918-734-7192
Mailing Address - Fax:918-589-2700
Practice Address - Street 1:2822 3RD AVE N STE 207
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1934
Practice Address - Country:US
Practice Address - Phone:406-601-9061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT50216101YM0800X
OK2869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2869OtherLPC