Provider Demographics
NPI:1649395195
Name:MARQUIS, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MARQUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 REAM AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9768
Mailing Address - Country:US
Mailing Address - Phone:530-926-1436
Mailing Address - Fax:
Practice Address - Street 1:1180 S MOUNT SHASTA BLVD STE B
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-2764
Practice Address - Country:US
Practice Address - Phone:530-926-1436
Practice Address - Fax:530-926-2305
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health