Provider Demographics
NPI:1821177296
Name:BUNN, LINDA L (MS,LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:BUNN
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 E 92ND ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-5319
Mailing Address - Country:US
Mailing Address - Phone:918-481-0685
Mailing Address - Fax:
Practice Address - Street 1:15 E DEWEY AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-4201
Practice Address - Country:US
Practice Address - Phone:918-227-1135
Practice Address - Fax:918-227-1135
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK56130Medicaid