Provider Demographics
NPI:1891991055
Name:PETERS, BETH RENAE (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:RENAE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10090 GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3894
Mailing Address - Country:US
Mailing Address - Phone:303-704-3612
Mailing Address - Fax:512-597-2829
Practice Address - Street 1:10090 GARRISON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3894
Practice Address - Country:US
Practice Address - Phone:303-704-3612
Practice Address - Fax:512-597-2829
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33019103TC2200X
COPSY.4004103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187080007Medicaid