Basic Information
| Provider Information | |||||||||
| NPI: | 1356622948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHEW | ||||||||
| FirstName: | LYNDA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS, LPC, CSOTP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 S J T STITES ST | ||||||||
| Address2: | |||||||||
| City: | SALLISAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749559301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187757787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 205 S J T STITES ST | ||||||||
| Address2: | |||||||||
| City: | SALLISAW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749559301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187757787 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2011 | ||||||||
| LastUpdateDate: | 06/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 101Y00000X | 5553 | OK | N | Behavioral Health & Social Service Providers | Counselor |
No ID Information.