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General NPI Number Information
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NPI Number | 1891991055
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Entity Type | Individual
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Provider Name | BETH RENAE PETERS PHD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 10090 GARRISON ST
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City | WESTMINSTER
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State | CO
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Zip | 80021-3894
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Country | US
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Telephone | 303-704-3612
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Fax | 512-597-2829
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Provider Business Mailing Address
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Address Line | 10090 GARRISON ST
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City | WESTMINSTER
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State | CO
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Zip | 80021-3894
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Country | US
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Telephone | 303-704-3612
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Fax | 512-597-2829
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 33019
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PSY.4004
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License Number State | CO
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