Provider Demographics
NPI:1760575856
Name:PETERS, CYNTHIA M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:M
Last Name:PETERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SW 34TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-2906
Mailing Address - Country:US
Mailing Address - Phone:806-355-0655
Mailing Address - Fax:806-355-0673
Practice Address - Street 1:7105 SW 34TH AVE STE F
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-2904
Practice Address - Country:US
Practice Address - Phone:806-355-0655
Practice Address - Fax:806-355-0673
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60133101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180943602Medicaid