MEDICARE: BETH RENAE PETERS PHD

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	103TC2200X	Clinical Child & Adolescent Psychologist	33019	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	PSY.4004	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891991055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH RENAE PETERS PHD

Provider Business Mailing Address
First Line	:	10090 GARRISON ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-3894
Country	:	US
Telephone Number	:	303-704-3612
Fax Number	:	512-597-2829

Provider Business Practice Location Address
First Line	:	10090 GARRISON ST
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-3894
Country	:	US
Telephone Number	:	303-704-3612
Fax Number	:	512-597-2829

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	02/12/2014

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Directions to “ BETH RENAE PETERS PHD” Practice Location

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