Provider Demographics
NPI:1649520834
Name:PEREDA-TORP, MARIA EUGENIA (MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:PEREDA-TORP
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12837 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-5067
Mailing Address - Country:US
Mailing Address - Phone:208-440-4485
Mailing Address - Fax:
Practice Address - Street 1:12837 N 11TH AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-5067
Practice Address - Country:US
Practice Address - Phone:208-440-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health