Peter Paul Lack

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

License

CP00006346 Issued in WA

Practice address

3804 Hastings Ave W
Port Townsend, WA 98368-9642

Phone

(360) 385-5505

Fax

(360) 385-3605

NPI assigned

Apr 30, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gray Wolf Ranch

  • Substance Abuse Rehabilitation Facility
  • Port Townsend, WA
  • NPI 1649546714
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398816000000",
    "number": "1033529987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983680102",
            "telephone_number": "360-385-5505",
            "fax_number": "360-385-3605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3804 HASTINGS AVE W",
            "city": "PORT TOWNSEND",
            "state": "WA",
            "postal_code": "983689642",
            "telephone_number": "360-385-5505",
            "fax_number": "360-385-3605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LACK",
        "first_name": "PETER",
        "middle_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-30",
        "last_updated": "2014-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CP00006346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Beth Krehbiel
• Marta Lee Krissovich, ANP-BC, CWOCN-AP
• Vanessa D Kroger, MA
• Dimitri D Kuznetsov, MD
• L'Chaim LLC
• Robert Laitman
• Susanne Lake
• Fernando E Lamas, M.D.
• Philippa D. Lance, OTR/L
• Denis James Langlois, ARNP

• Addiction (Substance Use Disorder) Psychologist in Port Townsend, WA
• Providers in Port Townsend, WA by specialty
• Addiction (Substance Use Disorder) Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.