Provider Demographics
NPI:1245582980
Name:PETERS, RITA (AMFT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:CEDAR FORT
Mailing Address - State:UT
Mailing Address - Zip Code:84013-0386
Mailing Address - Country:US
Mailing Address - Phone:801-766-8133
Mailing Address - Fax:
Practice Address - Street 1:197 E 100 S
Practice Address - Street 2:
Practice Address - City:CEDAR FORT
Practice Address - State:UT
Practice Address - Zip Code:84013
Practice Address - Country:US
Practice Address - Phone:801-766-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7133681-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist