Organization
LISA VAN TRIEST-PEADEN LCSW, INC., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA VAN TRIEST-PEADEN MSW,LCSW (PRESIDENT)
(580) 436-7120
Entity
Organization
Contact information
Practice address
2100 N BROADWAY AVE, ADA, OK 74820-1048
(580) 436-7120
Mailing address
2100 N BROADWAY AVE, ADA, OK 74820-1048
(580) 436-7120
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
2965
OK
Other
Enumeration date
03/03/2008
Last updated
12/22/2008
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