Provider Demographics
NPI:1932438801
Name:PETERS, STANLEY EARL JR (BA)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:EARL
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CROWN PT
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-5306
Mailing Address - Country:US
Mailing Address - Phone:580-465-8187
Mailing Address - Fax:
Practice Address - Street 1:15 CROWN PT
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-5306
Practice Address - Country:US
Practice Address - Phone:580-465-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor