Provider Demographics
NPI:1710246004
Name:PETERS, SYCHEEKIA S
Entity Type:Individual
Prefix:MS
First Name:SYCHEEKIA
Middle Name:S
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 SE 58TH PL
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135-4416
Mailing Address - Country:US
Mailing Address - Phone:405-317-8729
Mailing Address - Fax:
Practice Address - Street 1:11032 QUAIL CREEK RD
Practice Address - Street 2:SUITE 265
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6219
Practice Address - Country:US
Practice Address - Phone:405-751-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK27-5161815Medicaid