Provider Demographics
NPI:1669534814
Name:STIVERS, PETE LLOYD (PHD)
Entity type:Individual
Prefix:DR
First Name:PETE
Middle Name:LLOYD
Last Name:STIVERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-453-5563
Mailing Address - Fax:406-455-1248
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:SUITE 205
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-453-5563
Practice Address - Fax:406-455-1248
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT237103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist