Provider Demographics
NPI:1720127301
Name:PETERS, REBECCA MAE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:MAE
Last Name:PETERS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 DANDELION DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-5943
Mailing Address - Country:US
Mailing Address - Phone:360-923-0249
Mailing Address - Fax:360-586-7868
Practice Address - Street 1:111 ISRAEL RD SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-5570
Practice Address - Country:US
Practice Address - Phone:360-236-3532
Practice Address - Fax:360-586-7868
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health