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General NPI Number Information
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NPI Number | 1144618521
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Entity Type | Individual
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Provider Name | MARCY LYNN PETERS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 3350 W AMERICANA TER
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City | BOISE
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State | ID
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Zip | 83706-2521
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Country | US
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Telephone | 661-674-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 698 N MINERAL WELLS AVE
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City | MERIDIAN
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State | ID
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Zip | 83642-7610
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Country | US
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Telephone | 661-674-7104
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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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | CFH-10581
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8861122
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License Number State | ID
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