Provider Demographics
NPI:1063719938
Name:PERDUE, MANDIE (MS, LPC)
Entity type:Individual
Prefix:
First Name:MANDIE
Middle Name:
Last Name:PERDUE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:MELISSIA
Other - Middle Name:
Other - Last Name:PERDUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BUOYANCY COUNSELING
Mailing Address - Street 1:17212 SE LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3283
Mailing Address - Country:US
Mailing Address - Phone:580-951-0017
Mailing Address - Fax:
Practice Address - Street 1:17212 SE LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3283
Practice Address - Country:US
Practice Address - Phone:580-951-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1063719938OtherLICENSED PROFESSIONAL COUNSELOR