Healthcare Provider Details

I. General information

NPI: 1992424238
Provider Name (Legal Business Name): PEYTON PIELSTICKER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 05/28/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 W OAK LEAF DR
TULSA OK
74131
US

IV. Provider business mailing address

4900 W 71ST ST S
TULSA OK
74131-3459
US

V. Phone/Fax

Practice location:
  • Phone: 918-934-4010
  • Fax:
Mailing address:
  • Phone: 918-934-4010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number50092-0322
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21348
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: