1407986300 NPI number — MS. PEGGY MARIE DEWITT M.A., LMFT

Table of content: MS. PEGGY MARIE DEWITT M.A., LMFT (NPI 1407986300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407986300 NPI number — MS. PEGGY MARIE DEWITT M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWITT
Provider First Name:
PEGGY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARVER
Provider Other First Name:
PEGGY
Provider Other Middle Name:
ALENA' MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407986300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19737 KOALA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-227-7083
Provider Business Mailing Address Fax Number:
530-241-5148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 PARKVIEW AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDDING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96001-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-227-7083
Provider Business Practice Location Address Fax Number:
530-241-5148
Provider Enumeration Date:
03/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 35155 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: MFT35155 , 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)





Copyright © 2007-2025 www.npivalidator.com