DR. Gary Glen Peterson, PH.D.

NPI #1114130465 in Ketchum, Idaho

Provider Information

NPI Number: 1114130465
Entity Type: Individual
Name: DR. Gary Glen Peterson, PH.D.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist
Credential: PH.D.
Enumeration Date: May 7, 2007
Last Updated: Aug 5, 2010

Practice Location

Address: 675 SUN VALLEY ROAD
Address 2: C
City: Ketchum
State: Idaho
ZIP Code: 83340
Phone: (208) 928-6555

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X	Primary

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