Provider Demographics
NPI:1730602962
Name:PETERS, ALYSSA (LCPC)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 11TH AVE S STE 204
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-5074
Mailing Address - Country:US
Mailing Address - Phone:208-949-7927
Mailing Address - Fax:
Practice Address - Street 1:320 11TH AVE S STE 204
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-5074
Practice Address - Country:US
Practice Address - Phone:208-949-7927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6544101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor