Provider Demographics
NPI:1083878722
Name:PUCKETT, PEGGY S (MS, LPC-CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:S
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:MS, LPC-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 E KENNEMER
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-8401
Mailing Address - Country:US
Mailing Address - Phone:785-341-9082
Mailing Address - Fax:
Practice Address - Street 1:213 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4741
Practice Address - Country:US
Practice Address - Phone:580-774-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health