Provider Demographics
NPI:1487824413
Name:PETER STIVERS, PHD, PC
Entity Type:Organization
Organization Name:PETER STIVERS, PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:STIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-453-5563
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-453-5563
Mailing Address - Fax:
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:SUITE 205
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-453-5563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty