MEDICARE: MARCY LYNN PETERS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	CFH-10581	ID
2	1041C0700X	Clinical Social Worker	8861122	ID

General Provider Information

NPI Number	:	1144618521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCY LYNN PETERS LCSW

Provider Business Mailing Address
First Line	:	698 N MINERAL WELLS AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7610
Country	:	US
Telephone Number	:	661-674-7104
Fax Number	:

Provider Business Practice Location Address
First Line	:	698 N MINERAL WELLS AVE
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-7610
Country	:	US
Telephone Number	:	661-674-7104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	05/26/2026

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