Provider Demographics
NPI:1013073352
Name:MOFFATT, LINDA MARSHALL (LPC, LADC, ICAD)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARSHALL
Last Name:MOFFATT
Suffix:
Gender:F
Credentials:LPC, LADC, ICAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15612 TRADITIONS BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1116
Mailing Address - Country:US
Mailing Address - Phone:405-514-1561
Mailing Address - Fax:405-879-3446
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-514-1561
Practice Address - Fax:405-879-3446
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPC 504101Y00000X
OKLADC 425101YA0400X
ICADC 3978101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)