Provider Demographics
NPI:1528538519
Name:AUGUST, PETER J (LMFT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:AUGUST
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4171 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5175
Mailing Address - Country:US
Mailing Address - Phone:510-220-5152
Mailing Address - Fax:
Practice Address - Street 1:4171 PIEDMONT AVE APT SUITE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5175
Practice Address - Country:US
Practice Address - Phone:510-220-5152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist