Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS008155L | PA |
N | 103T00000X | Psychologist | PS008155L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS008155L | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS008155L | PA |
N | 103TC1900X | Counseling Psychologist | PS008155L | PA |
N | 103TF0000X | Family Psychologist | PS008155L | PA |
NPI | 1366554784 |
---|---|
Provider Name | Mark M Peters |
First Address | Huntingdon, PA 16652-2413 |
Second Address | Huntingdon, PA 16652-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1365219 | BLUE SHIELD (01) | PA |
207627 | VALUE OPTIONS (01) | PA |
401131 | BLUE SHIELD (MANAGED CARE (01) | PA |