Provider Demographics
NPI:1922739390
Name:LINDSAY BROOKE DLUGONSKI LLC
Entity Type:Organization
Organization Name:LINDSAY BROOKE DLUGONSKI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:DLUGONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-547-4087
Mailing Address - Street 1:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-0012
Mailing Address - Country:US
Mailing Address - Phone:580-547-4087
Mailing Address - Fax:580-278-2838
Practice Address - Street 1:545 S. 30TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601
Practice Address - Country:US
Practice Address - Phone:580-547-4087
Practice Address - Fax:580-275-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)