Healthcare Provider Details

I. General information

NPI: 1982983003
Provider Name (Legal Business Name): DEANNA M PETERS MA, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2011
Last Update Date: 08/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15802 N PARKVIEW PL
SURPRISE AZ
85374-7466
US

IV. Provider business mailing address

1421 S 167TH DR
GOODYEAR AZ
85338-7313
US

V. Phone/Fax

Practice location:
  • Phone: 623-523-8334
  • Fax: 623-523-8311
Mailing address:
  • Phone: 602-418-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number4374620
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: