Provider Demographics
NPI:1871757591
Name:PETERS, KRYLYN (LPC)
Entity type:Individual
Prefix:MS
First Name:KRYLYN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 W OLIVE AVE
Mailing Address - Street 2:SUITE 194
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-3843
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:602-629-1536
Practice Address - Street 1:4425 W OLIVE AVE
Practice Address - Street 2:SUITE 194
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-3843
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:602-629-1536
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health