Provider Demographics
NPI:1528028370
Name:PERSAC, BETH ELAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELAINE
Last Name:PERSAC
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6655 S YALE AVE
Mailing Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3326
Mailing Address - Country:US
Mailing Address - Phone:918-481-4000
Mailing Address - Fax:918-491-5740
Practice Address - Street 1:6655 S YALE AVE
Practice Address - Street 2:LAUREATE PSYCHIATRIC CLINIC AND HOSPITAL
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3326
Practice Address - Country:US
Practice Address - Phone:918-481-4000
Practice Address - Fax:918-491-5740
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2187192OtherCIGNA BEHAVIORAL HEALTH