1013374057 NPI number — LACEY PETERS

Table of content: STEVEN ROBERT MATULIS MD (NPI 1316955255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013374057 NPI number — LACEY PETERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LACEY PETERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013374057
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22552
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93121-2552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-451-7171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5276 HOLLISTER AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SANTA BARBARA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93111-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-451-7171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
LACEY
Authorized Official Middle Name:
JOHNSON
Authorized Official Title or Position:
MARRIAGE AND FAMILY THERAPIST
Authorized Official Telephone Number:
805-451-7171

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT77995 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LMFT77995 . This is a "BOARD OF BEHAVIORAL SCIENCES LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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