Provider Demographics
NPI:1740816966
Name:PETERS, RALPH RICHARD (LCSW)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:RICHARD
Last Name:PETERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:12655 WOODFOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-3564
Mailing Address - Country:US
Mailing Address - Phone:713-453-2300
Mailing Address - Fax:713-453-2300
Practice Address - Street 1:12655 WOODFOREST BLVD STE 700
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-3575
Practice Address - Country:US
Practice Address - Phone:713-453-2300
Practice Address - Fax:713-453-2300
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical