Provider Demographics
NPI:1982885166
Name:PETERS, DAVID KEITH (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KEITH
Last Name:PETERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 S LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4919
Mailing Address - Country:US
Mailing Address - Phone:918-637-2285
Mailing Address - Fax:918-561-6001
Practice Address - Street 1:1535 S LEWIS AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4919
Practice Address - Country:US
Practice Address - Phone:918-637-2285
Practice Address - Fax:918-561-6001
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1653101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health