Provider Demographics
NPI:1760657100
Name:PEETS, ROBERT VARDAMAN (BCBA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:VARDAMAN
Last Name:PEETS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LEANNE CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7671
Mailing Address - Country:US
Mailing Address - Phone:423-791-3371
Mailing Address - Fax:
Practice Address - Street 1:2 LEANNE CIR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7671
Practice Address - Country:US
Practice Address - Phone:423-791-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst