Healthcare Provider Details

I. General information

NPI: 1073842266
Provider Name (Legal Business Name): PETER SCOTT GEISSLER M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 01/15/2024
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE 4067
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

784 S CLEARWATER LOOP STE 4067
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 208-219-5285
  • Fax:
Mailing address:
  • Phone: 208-219-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberRC00055828
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberADD14039
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10129152
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH8935
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberRP-254
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT000063
License Number StateDC
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number842
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 9
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1059
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: