MEDICARE: MARK M PETERS M.A.

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist	PS008155L	PA
2	103TB0200X	Cognitive & Behavioral Psychologist	PS008155L	PA
3	103TC1900X	Counseling Psychologist	PS008155L	PA
4	103TF0000X	Family Psychologist	PS008155L	PA
5	103T00000X	Psychologist	PS008155L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	401131	OTHER	PA	BLUE SHIELD (MANAGED CARE
2	1365219	OTHER	PA	BLUE SHIELD
3	207627	OTHER	PA	VALUE OPTIONS

General Provider Information

NPI Number	:	1366554784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK M PETERS M.A.

Provider Business Mailing Address
First Line	:	900 BRYAN ST
Second Line	:	SUITE 5
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2413
Country	:	US
Telephone Number	:	814-643-6300
Fax Number	:	814-643-8776

Provider Business Practice Location Address
First Line	:	900 BRYAN ST
Second Line	:	SUITE 5
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2413
Country	:	US
Telephone Number	:	814-643-6300
Fax Number	:	814-643-8776

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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Directions to “ MARK M PETERS M.A.” Practice Location

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