Provider Demographics
NPI:1578379061
Name:JOHNSON, LINDY MEGAN GREEN (LCSW)
Entity type:Individual
Prefix:
First Name:LINDY
Middle Name:MEGAN GREEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LINDY
Other - Middle Name:MEGAN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:8300 NW 159TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5817
Mailing Address - Country:US
Mailing Address - Phone:405-973-6585
Mailing Address - Fax:
Practice Address - Street 1:8300 NW 159TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5817
Practice Address - Country:US
Practice Address - Phone:405-973-6585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1035961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical