Provider Demographics
NPI:1750804407
Name:PECKENPAUGH, MARSHA KAY
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:KAY
Last Name:PECKENPAUGH
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 1:405 N HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-2615
Mailing Address - Country:US
Mailing Address - Phone:918-864-7724
Mailing Address - Fax:
Practice Address - Street 1:24797 S HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2411
Practice Address - Country:US
Practice Address - Phone:918-342-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor