Healthcare Provider Details

I. General information

NPI: 1902555899
Provider Name (Legal Business Name): JOHN PETERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8145 E EVANS RD STE 6
SCOTTSDALE AZ
85260-3645
US

IV. Provider business mailing address

8145 E EVANS RD STE 6
SCOTTSDALE AZ
85260-3645
US

V. Phone/Fax

Practice location:
  • Phone: 480-508-7571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: