Provider Demographics
NPI:1609877232
Name:PETERS, JAMES WARNER (MA LPC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WARNER
Last Name:PETERS
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2760
Mailing Address - Country:US
Mailing Address - Phone:307-632-9362
Mailing Address - Fax:307-637-6852
Practice Address - Street 1:510 W 29TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2760
Practice Address - Country:US
Practice Address - Phone:307-632-9362
Practice Address - Fax:307-637-6852
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY593101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
312401OtherBS