Provider Demographics
NPI:1760839344
Name:BIRKHOLZ, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BIRKHOLZ
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 1:13 CHAPARRAL TRL
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-9131
Mailing Address - Country:US
Mailing Address - Phone:307-254-5648
Mailing Address - Fax:
Practice Address - Street 1:13 CHAPARRAL TRL
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-9131
Practice Address - Country:US
Practice Address - Phone:307-254-5648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD33331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical