Provider Demographics
NPI:1700228145
Name:PETTIFORD, SHARRON M (CBCM II)
Entity Type:Individual
Prefix:MISS
First Name:SHARRON
Middle Name:M
Last Name:PETTIFORD
Suffix:
Gender:F
Credentials:CBCM II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 S HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-5422
Mailing Address - Country:US
Mailing Address - Phone:918-397-0370
Mailing Address - Fax:
Practice Address - Street 1:1661 S HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-5422
Practice Address - Country:US
Practice Address - Phone:918-397-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13397103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst