Provider Demographics
NPI:1881995918
Name:PETERS, KATHRINA L (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRINA
Middle Name:L
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 UPLAND DR # 2583
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4718
Mailing Address - Country:US
Mailing Address - Phone:510-282-5174
Mailing Address - Fax:510-550-2549
Practice Address - Street 1:17 EMBARCADERO CV
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5214
Practice Address - Country:US
Practice Address - Phone:510-282-5174
Practice Address - Fax:510-550-2548
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48987106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist