Provider Demographics
NPI:1659619815
Name:PETERS, AMBER (EDS)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 ZERMATT AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-8323
Mailing Address - Country:US
Mailing Address - Phone:815-298-3849
Mailing Address - Fax:
Practice Address - Street 1:533 CHURCH ST.
Practice Address - Street 2:#167
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37219-5994
Practice Address - Country:US
Practice Address - Phone:815-298-3849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-15-17968103K00000X
AR316103TS0200X
AR1-15-17968103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool