Provider Demographics
NPI:1861417875
Name:PETERS, DONN W (PSYD)
Entity type:Individual
Prefix:DR
First Name:DONN
Middle Name:W
Last Name:PETERS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 BITNER RD
Mailing Address - Street 2:K-33
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5404
Mailing Address - Country:US
Mailing Address - Phone:435-649-6838
Mailing Address - Fax:
Practice Address - Street 1:2024 SIDEWINDER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7365
Practice Address - Country:US
Practice Address - Phone:435-649-6838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT312303-2501101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00030109Medicare ID - Type Unspecified
UTS05797Medicare UPIN