Provider Demographics
NPI:1811678733
Name:PETREE, ISABEL
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:PETREE
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 1:4308 OAK WALK N
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-5945
Mailing Address - Country:US
Mailing Address - Phone:470-380-2114
Mailing Address - Fax:
Practice Address - Street 1:4308 OAK WALK N
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-5945
Practice Address - Country:US
Practice Address - Phone:470-380-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst