Provider Demographics
NPI:1376696484
Name:BREWER, PETER M (MA LMHP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BREWER
Suffix:
Gender:M
Credentials:MA LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 GOLD COAST RD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2826
Mailing Address - Country:US
Mailing Address - Phone:402-331-3477
Mailing Address - Fax:402-331-3557
Practice Address - Street 1:1301 GOLD COAST RD
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2826
Practice Address - Country:US
Practice Address - Phone:402-331-3477
Practice Address - Fax:402-331-3557
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELMHP 156 CPC 470101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health