Provider Demographics
NPI:1790963288
Name:LINDE, SUSAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:M
Last Name:LINDE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4812 E 81ST ST
Mailing Address - Street 2:STE 303
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-1916
Mailing Address - Country:US
Mailing Address - Phone:918-747-5565
Mailing Address - Fax:918-747-5568
Practice Address - Street 1:4812 E 81ST ST
Practice Address - Street 2:STE 303
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-1916
Practice Address - Country:US
Practice Address - Phone:918-747-5565
Practice Address - Fax:918-747-5568
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1055103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200132320AMedicaid
OK200132320AMedicaid