Provider Demographics
NPI:1558305698
Name:PETERS, SCOTT W (LPC)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:W
Last Name:PETERS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FUNSTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6519
Mailing Address - Country:US
Mailing Address - Phone:210-473-1433
Mailing Address - Fax:210-821-5614
Practice Address - Street 1:142 FUNSTON PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6519
Practice Address - Country:US
Practice Address - Phone:210-473-1433
Practice Address - Fax:210-821-5614
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX177607201Medicaid