Provider Demographics
NPI:1215378096
Name:PETERS, JOLANDA CHERAE (BHRS)
Entity type:Individual
Prefix:
First Name:JOLANDA
Middle Name:CHERAE
Last Name:PETERS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 RIDGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-7535
Mailing Address - Country:US
Mailing Address - Phone:405-706-3436
Mailing Address - Fax:
Practice Address - Street 1:3310 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-7535
Practice Address - Country:US
Practice Address - Phone:405-706-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst