Healthcare Provider Details

I. General information

NPI: 1477047108
Provider Name (Legal Business Name): RACHEL ANN PETERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2018
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N GREENWOOD AVE STE 131
TULSA OK
74120-1444
US

IV. Provider business mailing address

6011 S 76TH EAST AVE
TULSA OK
74145-9340
US

V. Phone/Fax

Practice location:
  • Phone: 918-599-7277
  • Fax:
Mailing address:
  • Phone: 918-636-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: