Provider Demographics
NPI:1760729917
Name:DEBBINK, PETER (MA, NCE, LPC-IT)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:DEBBINK
Suffix:
Gender:M
Credentials:MA, NCE, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6314 ODANA RD STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1194
Mailing Address - Country:US
Mailing Address - Phone:608-277-2966
Mailing Address - Fax:
Practice Address - Street 1:6314 ODANA RD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1194
Practice Address - Country:US
Practice Address - Phone:608-277-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1625-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional