Individual
MISS GAY LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
323 W 6TH ST, OKMULGEE, OK 74447-5019
(918) 756-9250
Mailing address
1116 S FLORIDA AVE, OKMULGEE, OK 74447-6200
(918) 756-4512
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300522336
MEDICARE
OK
Enumeration date
06/26/2007
Last updated
03/19/2009
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