Healthcare Provider Details

I. General information

NPI: 1548484173
Provider Name (Legal Business Name): JOHN EARL PEPTIS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR EBHT-2 BLDG 2361
FT CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIR EBHT-2 BLDG 2361
FT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-3547
  • Fax: 719-526-3816
Mailing address:
  • Phone: 719-526-3547
  • Fax: 719-526-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSCSW1024
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: