Provider Demographics
NPI:1528386539
Name:PETRIN, ELIZABETH MURPHY (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MURPHY
Last Name:PETRIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E BROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-2906
Mailing Address - Country:US
Mailing Address - Phone:405-624-2366
Mailing Address - Fax:
Practice Address - Street 1:921 E BROOKE AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-2906
Practice Address - Country:US
Practice Address - Phone:405-624-2366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK867103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist