Provider Demographics
NPI:1346921400
Name:PETERS, BETH N
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:N
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:ALAN RIAN
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11201 NW 114TH ST
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8783
Mailing Address - Country:US
Mailing Address - Phone:405-474-9764
Mailing Address - Fax:
Practice Address - Street 1:416 W 15TH ST STE 600
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3672
Practice Address - Country:US
Practice Address - Phone:479-318-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst