Individual
MARYN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PARAPROFESSIONAL
Contact information
Practice address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 237-1711
(208) 237-9806
Mailing address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 237-1711
(208) 237-9806
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
11/19/2025
Last updated
11/19/2025
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