Individual
MR. JERMAINE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
2701 N OKLAHOMA AVE, OKLAHOMA CITY, OK 73105-2724
(405) 524-2673
Mailing address
9220 E 50TH ST, TULSA, OK 74145-7327
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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