Provider Demographics
NPI:1699983700
Name:PETER, H. MIGNONNE (MA ABS)
Entity type:Individual
Prefix:MRS
First Name:H.
Middle Name:MIGNONNE
Last Name:PETER
Suffix:
Gender:F
Credentials:MA ABS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 58TH ST NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1501
Mailing Address - Country:US
Mailing Address - Phone:253-927-0322
Mailing Address - Fax:
Practice Address - Street 1:1807 58TH ST NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1501
Practice Address - Country:US
Practice Address - Phone:253-927-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist