Provider Demographics
NPI:1972859841
Name:PETERS, COURTNEY (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-194
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-5390
Mailing Address - Country:US
Mailing Address - Phone:602-999-2987
Mailing Address - Fax:
Practice Address - Street 1:4340 E INDIAN SCHOOL RD STE 21-194
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018
Practice Address - Country:US
Practice Address - Phone:602-999-2987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst