Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. GARY GLEN PETERSON, PH.D.
Active Sole ProprietorDR. GARY GLEN PETERSON, PH.D. is a Psychologist healthcare provider located in KETCHUM, Idaho. NPI 1114130465 is currently active in the NPPES registry. Verify at CMS.
Psychologist · KETCHUM, ID
Registration Details
- NPI Number
- 1114130465
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- May 7, 2007 (19.301081437907 yrs)
- Last Updated
- Aug 5, 2010
- Licenses
-
7790 (CA)PSY 202479 (ID)578 (AZ)
- Sole Proprietor
- Yes
Practice Information
- Address
-
675 SUN VALLEY ROADCKETCHUM, ID, 83340Browse ID providers · Browse ZIP 83340
- Phone
- 2089286555
- Fax
- 2089287666
- Primary Specialty
-
Psychologist
103T00000X
- Additional Specialty
- Psychologist
- Additional Specialty
- Psychologist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.