Provider Demographics
NPI:1265622476
Name:PEGGY MAKI -WHITE PHD LLC
Entity type:Organization
Organization Name:PEGGY MAKI -WHITE PHD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:MAKI-WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-286-8765
Mailing Address - Street 1:P.O. BOX 173
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:970-286-8765
Mailing Address - Fax:
Practice Address - Street 1:1226 WEST ASH
Practice Address - Street 2:SUITE F
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-286-8765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3593103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1720171382OtherMEDICARE ADVANTAGE
CO3699754OtherCIGNA
3699754OtherVALUE OPTION
HIH101470Medicare PIN