Provider Demographics
NPI:1568570612
Name:PETERS, MARY L (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 5TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-1580
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:627 5TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-1580
Practice Address - Country:US
Practice Address - Phone:206-200-3957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00010792OtherSTATE LICENSE