Provider Demographics
NPI:1699057786
Name:GEORGE, LINDA M (MHR LPC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:M
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MHR LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MAIN ST
Mailing Address - Street 2:#103
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-5136
Mailing Address - Country:US
Mailing Address - Phone:405-912-7730
Mailing Address - Fax:405-912-7726
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:#103
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-5136
Practice Address - Country:US
Practice Address - Phone:405-912-7730
Practice Address - Fax:405-912-7726
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3395101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health