Provider Demographics
NPI:1104157072
Name:LINDSTROM, ANGELA DANISE (BA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:DANISE
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 S HEMLOCK AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9050
Mailing Address - Country:US
Mailing Address - Phone:918-557-5910
Mailing Address - Fax:
Practice Address - Street 1:1516 S BOSTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-4003
Practice Address - Country:US
Practice Address - Phone:918-561-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health