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General NPI Number Information
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NPI Number | 1164711024
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Entity Type | Individual
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Provider Name | BEVERLY PETRA RICE LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 1801 N HIGHWAY 66
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City | CATOOSA
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State | OK
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Zip | 74015-3067
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Country | US
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Telephone | 918-805-1526
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Fax | 918-777-9720
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Provider Business Mailing Address
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Address Line | 8437 N 77TH EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-7417
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Country | US
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Telephone | 918-805-1526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 3464
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4992
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License Number State | OK
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