Provider Demographics
NPI:1265082176
Name:LANDSWICK, PETER (LCDC-I)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LANDSWICK
Suffix:
Gender:M
Credentials:LCDC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15731 COTTON TAIL LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-1200
Mailing Address - Country:US
Mailing Address - Phone:210-620-4189
Mailing Address - Fax:
Practice Address - Street 1:7428 W MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-3010
Practice Address - Country:US
Practice Address - Phone:210-673-8111
Practice Address - Fax:210-670-8740
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46710101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)