Active NPI
Lawrence Peltz
- Marriage & Family Therapist
- Santa Rosa, CA
National Provider Identifier
1831581115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- LMFT12862
- Practice address
- 1212 College Ave
Santa Rosa, CA 95404-3976 - Phone
- (707) 545-2728
- Fax
- (630) 839-6371
- NPI assigned
- Feb 24, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | LMFT12862 | CA | Primary |
Addresses
Primary practice location
1212 College Ave
Santa Rosa, CA 95404-3976
Mailing address
1212 College Ave
Santa Rosa, CA 95404-3976
Phone (707) 545-2728
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 25, 2024 through Jul 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMFT12862 | CA | MD | Marriage & Family Therapist |
| 12862 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1424736000000",
"number": "1831581115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 COLLEGE AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043976",
"telephone_number": "707-545-2728",
"fax_number": "630-839-6371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 COLLEGE AVE",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954043976",
"telephone_number": "707-545-2728",
"fax_number": "630-839-6371"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELTZ",
"first_name": "LAWRENCE",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-02-24",
"last_updated": "2015-02-24",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "LMFT12862",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2015; 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.