Provider Demographics
NPI:1598971889
Name:DONN PETERS PSYD PC
Entity Type:Organization
Organization Name:DONN PETERS PSYD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONN
Authorized Official - Middle Name:W
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:435-649-6838
Mailing Address - Street 1:900 BITNER RD
Mailing Address - Street 2:K-33
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5404
Mailing Address - Country:US
Mailing Address - Phone:435-644-9683
Mailing Address - Fax:
Practice Address - Street 1:2024 SIDEWINDER DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7365
Practice Address - Country:US
Practice Address - Phone:435-649-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT312303-2501251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS05797Medicare UPIN