Provider Demographics
NPI:1962636803
Name:PETERS, BRANDEN D
Entity Type:Individual
Prefix:
First Name:BRANDEN
Middle Name:D
Last Name:PETERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 BERING
Mailing Address - Street 2:SUITE 940
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057
Mailing Address - Country:US
Mailing Address - Phone:281-921-1818
Mailing Address - Fax:281-921-1919
Practice Address - Street 1:9100 SOUTHWEST FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1519
Practice Address - Country:US
Practice Address - Phone:713-457-4372
Practice Address - Fax:713-457-0945
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62669101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX62669Medicaid