Individual
LIVINIUS CHARLES PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
1609 GREENBRIAR PL, OKLAHOMA CITY, OK 73159-7640
(405) 735-3683
Mailing address
1812 FOXFIRE RD, EDMOND, OK 73003-6202
(405) 509-1180
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200033660
—
OK
Enumeration date
06/15/2011
Last updated
06/15/2011
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