Provider Demographics
NPI:1295946036
Name:PETERS, CHASTITY (MHA)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 KENTUCKY ROUTE 1428
Mailing Address - Street 2:
Mailing Address - City:HAGER HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41222
Mailing Address - Country:US
Mailing Address - Phone:606-789-3841
Mailing Address - Fax:606-202-1428
Practice Address - Street 1:1520 KENTUCKY ROUTE 1428
Practice Address - Street 2:
Practice Address - City:HAGER HILL
Practice Address - State:KY
Practice Address - Zip Code:41222
Practice Address - Country:US
Practice Address - Phone:606-789-3518
Practice Address - Fax:606-789-3530
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health