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General NPI Number Information
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NPI Number | 1053265892
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Entity Type | Individual
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Provider Name | EMILY RAINE PETERS LAC
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Gender | Female
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Dates
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Enumeration Date | 02/26/2026
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Last Update Date | 02/26/2026
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Provider Practice Location Address
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Address Line | 5727 N 7TH ST UNIT 557
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City | PHOENIX
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State | AZ
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Zip | 85014-0036
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Country | US
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Telephone | 704-451-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 19820 N 7TH ST STE 145
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City | PHOENIX
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State | AZ
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Zip | 85024-1691
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Country | US
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Telephone | 704-451-9073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LAC-23559
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License Number State | AZ
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