Provider Demographics
NPI:1891103099
Name:GEORGE E. PETERS COUNSELING, PLLC
Entity Type:Organization
Organization Name:GEORGE E. PETERS COUNSELING, PLLC
Other - Org Name:GEORGE E. PETERS COUNSELING
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:III
Authorized Official - Credentials:MA, LPC, CCTP, RPT
Authorized Official - Phone:405-314-4891
Mailing Address - Street 1:15803 NE 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHOCTAW
Mailing Address - State:OK
Mailing Address - Zip Code:73020-8428
Mailing Address - Country:US
Mailing Address - Phone:405-314-4891
Mailing Address - Fax:
Practice Address - Street 1:15803 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8428
Practice Address - Country:US
Practice Address - Phone:405-314-4891
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200443510BMedicaid