Provider Demographics
NPI:1669622379
Name:TRUNDLE, LYNN
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:TRUNDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N NAVAJO AVENUE
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337
Mailing Address - Country:US
Mailing Address - Phone:918-476-5264
Mailing Address - Fax:
Practice Address - Street 1:12005 E 470 ROAD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017
Practice Address - Country:US
Practice Address - Phone:918-342-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health