Provider Demographics
NPI:1790251817
Name:PETER, DARLA G (SCHOOL PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:G
Last Name:PETER
Suffix:
Gender:F
Credentials:SCHOOL PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:TUSCOLA
Mailing Address - State:TX
Mailing Address - Zip Code:79562-0366
Mailing Address - Country:US
Mailing Address - Phone:325-201-6870
Mailing Address - Fax:
Practice Address - Street 1:5646 FM 89
Practice Address - Street 2:
Practice Address - City:TUSCOLA
Practice Address - State:TX
Practice Address - Zip Code:79562-2808
Practice Address - Country:US
Practice Address - Phone:325-201-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31959103TS0200X
OHTX1001377103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Single Specialty