Provider Demographics
NPI:1992773097
Name:TERPSTRA, PEGGY REESE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:REESE
Last Name:TERPSTRA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:ELIZABETH
Other - Last Name:TERPSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1003 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3502
Mailing Address - Country:US
Mailing Address - Phone:515-267-1003
Mailing Address - Fax:515-267-0100
Practice Address - Street 1:1003 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-3502
Practice Address - Country:US
Practice Address - Phone:515-267-1003
Practice Address - Fax:515-267-0100
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1045898Medicaid
IAIA0104OtherJOHN DEERE HC