Provider Demographics
NPI:1689753584
Name:RACKLEY, PEGGY
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:RACKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:3855 SOUTH BOULEVARD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OH
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-340-4321
Mailing Address - Fax:405-340-9408
Practice Address - Street 1:3855 SOUTH BOULEVARD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-340-4321
Practice Address - Fax:405-340-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health