Provider Demographics
NPI:1306814009
Name:PELTIER, STEVEN W (PHD, LP, LMFT)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:W
Last Name:PELTIER
Suffix:
Gender:M
Credentials:PHD, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 RAMSEY ST
Practice Address - Street 2:RAMSEY PROFESSIONAL BLDG.
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2323
Practice Address - Country:US
Practice Address - Phone:651-293-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1278103T00000X, 103TC0700X
MNC0741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31B13PEOtherBCBS INDIVIDUAL #
MN01009938OtherPREFERRED ONE
MN31B12PEOtherBLUE CROSS BLUE SHIELD MN