| Doctor Name: | MYLINDA RENEE FANJ |
| NPI Number: | 1255617015 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., LPC (US) |
| License Number: | (US) 966 |
| Business Practice Address: | 109 S Harrill Ave Wagoner, OK - 744675317 |
| Business Phone Number: | 9184853554 |
| Business Fax Number: | |
| Mailing Address: | 109 S Harrill Ave, WAGONER |
| State: | OK |
| Postal Code: | 744675317 |
| Phone Number: | 9184853554 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2011 |
| NPI Last Update Date: | 10/25/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | (US) 966 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |