MEDICARE: MR. PETER J SEUFFERT MS, LMFT

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	106H00000X	Marriage & Family Therapist	MFT00071	RI
2	106H00000X	Marriage & Family Therapist	954	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	251435	OTHER	RI	MHN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1619062791	OTHER	RI	BCBSRI

General Provider Information

NPI Number	:	1619062791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER J SEUFFERT MS, LMFT

Provider Business Mailing Address
First Line	:	8071 BUCKEYE TREE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4027
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8071 BUCKEYE TREE LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80927-4027
Country	:	US
Telephone Number	:	719-314-4264
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/24/2012

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