Provider Demographics
NPI:1245677509
Name:BOYCE, PEGGY JEAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:JEAN
Last Name:BOYCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:JEAN
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2920 E 95TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-8701
Mailing Address - Country:US
Mailing Address - Phone:918-440-6094
Mailing Address - Fax:
Practice Address - Street 1:2920 E 95TH PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-8701
Practice Address - Country:US
Practice Address - Phone:918-440-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA4124101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4124OtherOKLAHOMA BOARD OF LICENSED SOCIAL WORKERS LICENSE #