Provider Demographics
NPI:1558682823
Name:PETERS, CARLA MILES (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:MILES
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:CARLA
Other - Middle Name:MILES
Other - Last Name:BLEIDT-PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1500 NORTHCREST DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-1042
Mailing Address - Country:US
Mailing Address - Phone:254-772-2004
Mailing Address - Fax:
Practice Address - Street 1:1500 NORTHCREST DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1042
Practice Address - Country:US
Practice Address - Phone:254-772-2004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical