Provider Demographics
NPI:1275353922
Name:PETERS, MARION ELISE
Entity type:Individual
Prefix:MS
First Name:MARION
Middle Name:ELISE
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 PLACER HILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9380
Mailing Address - Country:US
Mailing Address - Phone:503-310-4120
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1257
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:OR
Practice Address - Zip Code:97535-1257
Practice Address - Country:US
Practice Address - Phone:541-535-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor