Provider Demographics
NPI:1699179242
Name:VANDERSTEEN, PETER JOHN (MA, LMHC, LCPC, CADC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:VANDERSTEEN
Suffix:
Gender:M
Credentials:MA, LMHC, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PONDEROSA CT APT 101
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3453
Mailing Address - Country:US
Mailing Address - Phone:208-717-1130
Mailing Address - Fax:
Practice Address - Street 1:403 PONDEROSA CT APT 101
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3453
Practice Address - Country:US
Practice Address - Phone:208-717-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCADC-5045101YA0400X
WALH60898613101YM0800X
IDLCPC-9428101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)