Provider Demographics
NPI:1760586945
Name:PETERS, BILL B (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:B
Last Name:PETERS
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 GIANT CEDAR DR.
Mailing Address - Street 2:
Mailing Address - City:WHITNEY
Mailing Address - State:TX
Mailing Address - Zip Code:76692-2253
Mailing Address - Country:US
Mailing Address - Phone:254-694-0858
Mailing Address - Fax:270-573-7794
Practice Address - Street 1:203 E JEFFERSON AVE STE A
Practice Address - Street 2:
Practice Address - City:WHITNEY
Practice Address - State:TX
Practice Address - Zip Code:76692-2303
Practice Address - Country:US
Practice Address - Phone:254-694-9457
Practice Address - Fax:270-573-7794
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS106351041C0700X
TX2511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87628QOtherBCBS
TX87628QOtherBCBS