Provider Demographics
NPI:1265943161
Name:BEWIE, PETER JUNIOR KEMOH (CPST)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JUNIOR KEMOH
Last Name:BEWIE
Suffix:
Gender:M
Credentials:CPST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 WHITE PINE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3650
Mailing Address - Country:US
Mailing Address - Phone:614-668-7627
Mailing Address - Fax:614-225-0991
Practice Address - Street 1:16 W LONG ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-2815
Practice Address - Country:US
Practice Address - Phone:614-225-0990
Practice Address - Fax:614-225-0991
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health