Mary Peterson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1671 Issued in OR

Practice address

414 N Meridian St
Box 6275
Newberg, OR 97132-2697

Phone

(503) 554-2377

NPI assigned

Jan 5, 2007

Sex

Female

Sole proprietor

Yes

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

Opted out of Medicare

Yes, effective Feb 8, 2023 through Feb 8, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

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.

• Regional West Physicians Clinic

  • Family Medicine Physician
  • Scottsbluff, NE
  • NPI 1306910534

  Clinical

  NPD (past)
• Regional West Physicians Clinic

  • Rural Health Clinic/Center
  • Mitchell, NE
  • NPI 1992703425
  NPD (past)

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720135163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 HILLTOP DR",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971329027",
            "telephone_number": "503-538-2831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 N MERIDIAN ST",
            "address_2": "BOX 6275",
            "city": "NEWBERG",
            "state": "OR",
            "postal_code": "971322697",
            "telephone_number": "503-554-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1671",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Peters, M.A.
• Martin Peters, DO
• Brittany Jane Peterson
• Janet Peterson, DRPH, RDN, FACSM
• Kylee Marie Peterson, MAQMHP
• Nadege Petrie
• Nathan Glenndale Phelps, DPT
• Jamie Phillips
• Jimmie Phillips Jr.
• Darby Philpot

• Clinical Psychologist in Newberg, OR
• Providers in Newberg, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.