Provider Demographics
NPI:1124374558
Name:LAURA PEITZ COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:LAURA PEITZ COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:PEITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-763-2802
Mailing Address - Street 1:1912 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74604-4800
Mailing Address - Country:US
Mailing Address - Phone:580-762-6511
Mailing Address - Fax:580-762-6511
Practice Address - Street 1:1912 LAKE RD
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74604-4800
Practice Address - Country:US
Practice Address - Phone:580-762-6511
Practice Address - Fax:580-762-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3813251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health