Healthcare Provider Details

I. General information

NPI: 1366554784
Provider Name (Legal Business Name): MARK M PETERS M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BRYAN ST SUITE 5
HUNTINGDON PA
16652-2413
US

IV. Provider business mailing address

900 BRYAN ST SUITE 5
HUNTINGDON PA
16652-2413
US

V. Phone/Fax

Practice location:
  • Phone: 814-643-6300
  • Fax: 814-643-8776
Mailing address:
  • Phone: 814-643-6300
  • Fax: 814-643-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008155L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPS008155L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS008155L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS008155L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS008155L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: