Provider Demographics
NPI:1679674287
Name:PETERS, MICHAEL C (LSCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:PETERS
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 LAMAR AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3234
Mailing Address - Country:US
Mailing Address - Phone:913-831-2550
Mailing Address - Fax:913-826-1589
Practice Address - Street 1:6000 LAMAR AVE
Practice Address - Street 2:STE 130
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3234
Practice Address - Country:US
Practice Address - Phone:913-831-2550
Practice Address - Fax:913-826-1589
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098010Medicaid
19019035OtherBCBS OF KC
2924950BMedicare ID - Type Unspecified
19019035OtherBCBS OF KC