Provider Demographics
NPI:1174230015
Name:PETERS, MALORI VICTORIA
Entity type:Individual
Prefix:
First Name:MALORI
Middle Name:VICTORIA
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 1:4210 110TH ST SW APT 12
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7505
Mailing Address - Country:US
Mailing Address - Phone:253-753-6031
Mailing Address - Fax:
Practice Address - Street 1:4210 110TH ST SW APT 12
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7505
Practice Address - Country:US
Practice Address - Phone:253-753-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health