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General NPI Number Information
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NPI Number | 1124374558
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Entity Type | Organization
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Legal Business Name | LAURA PEITZ COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/03/2012
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Last Update Date | 08/03/2012
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Provider Practice Location Address
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Address Line | 1912 LAKE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-4800
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Country | US
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Telephone | 580-762-6511
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Fax | 580-762-6511
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Provider Business Mailing Address
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Address Line | 1912 LAKE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-4800
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Country | US
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Telephone | 580-762-6511
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Fax | 580-762-6511
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MRS. LAURA ANNE PEITZ
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Credential | LPC
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Telephone | 580-763-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 3813
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License Number State | OK
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