Provider Demographics
NPI:1881839314
Name:PETERS, SHAQUETA SHREERIE (BA)
Entity Type:Individual
Prefix:
First Name:SHAQUETA
Middle Name:SHREERIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREER DR
Mailing Address - Street 2:APT. 10B
Mailing Address - City:DAVIS
Mailing Address - State:OK
Mailing Address - Zip Code:73030-2741
Mailing Address - Country:US
Mailing Address - Phone:580-369-2511
Mailing Address - Fax:
Practice Address - Street 1:2530 S. COMMERCE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:580-223-2537
Practice Address - Fax:580-223-2487
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health