Provider Demographics
NPI:1033554035
Name:GILBREATH, PEGGY (BS)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:
Last Name:GILBREATH
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:ATOKA
Mailing Address - State:OK
Mailing Address - Zip Code:74525-2047
Mailing Address - Country:US
Mailing Address - Phone:580-889-4717
Mailing Address - Fax:580-889-4707
Practice Address - Street 1:303 E COURT ST
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-2047
Practice Address - Country:US
Practice Address - Phone:580-889-4717
Practice Address - Fax:580-889-4707
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor