Provider Demographics
NPI:1346414729
Name:PETERS, MICHAEL (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PETERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1901 CENTRAL DR
Mailing Address - Street 2:STE 700
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-5869
Mailing Address - Country:US
Mailing Address - Phone:817-354-1234
Mailing Address - Fax:
Practice Address - Street 1:1901 CENTRAL DR
Practice Address - Street 2:STE 700
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-5869
Practice Address - Country:US
Practice Address - Phone:817-354-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12670101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83540LOtherBLUE CROSS BLUE SHIELD