Provider Demographics
NPI:1164711024
Name:RICE, BEVERLY PETRA (LCSW)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:PETRA
Last Name:RICE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8437 N 77TH EAST AVE
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-7417
Mailing Address - Country:US
Mailing Address - Phone:918-805-1526
Mailing Address - Fax:
Practice Address - Street 1:1801 N HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-3067
Practice Address - Country:US
Practice Address - Phone:918-805-1526
Practice Address - Fax:918-777-9720
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3464104100000X
OK49921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker