Peter J Theobald
Individual provider Active NPI Counselor · Spokane, WA
NPI 1659569481 · NPPES record last updated Oct 5, 2007
Key facts
- NPI
- 1659569481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- RC00058671 (WA)
- Practice address
- 3919 N Maple St
Spokane, WA 99205-1349 - Phone
- (509) 444-8888
- Fax
- (509) 444-7806
- NPI assigned
- Oct 5, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RC00058671 | WA | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | RC00058671 | WA | Yes |
Addresses
Primary practice location
3919 N Maple St
Spokane, WA 99205-1349
Mailing address
3919 N Maple St
Spokane, WA 99205-1349
Phone (509) 444-8888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RC00058671 | Other | WA | COUNSELOR |
Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.