Individual
SANDRA PETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
209 EAST 6 STREET, GROVE, OK 74345
(918) 786-8830
Mailing address
PO BOX 451836, GROVE, OK 74345-1836
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
564
OK
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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