Individual
CARRIE PETTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S MAIN ST, MCALESTER, OK 74501-5363
(918) 423-5204
Mailing address
111 S MAIN ST, MCALESTER, OK 74501-5363
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
REHAB
REHAB
—
Enumeration date
02/22/2012
Last updated
03/07/2012
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