Provider Demographics
NPI:1447279278
Name:ROBERTS, PEGGY J (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 LONGWOOD CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3413
Mailing Address - Country:US
Mailing Address - Phone:972-768-4298
Mailing Address - Fax:
Practice Address - Street 1:27B SOUTH WEST
Practice Address - Street 2:SUITE #100 AND #200
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401
Practice Address - Country:US
Practice Address - Phone:918-388-6227
Practice Address - Fax:918-388-6456
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional