Provider Demographics
NPI:1265509210
Name:PETERS, CAROL CATHERINE (LMHC LICENSED MENTAL)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:CATHERINE
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMHC LICENSED MENTAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 NE 66TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5553
Mailing Address - Country:US
Mailing Address - Phone:206-282-2180
Mailing Address - Fax:
Practice Address - Street 1:843 NE 66TH STREET
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5553
Practice Address - Country:US
Practice Address - Phone:206-282-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PE7496OtherREGENCE HEALTH INSURANCE