MEDICARE: RICHARD HERCHEL PETERS JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CI43830724	CA

General Provider Information

NPI Number	:	1720803257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD HERCHEL PETERS JR.

Provider Business Mailing Address
First Line	:	4038 MCCLAIN WAY APT 101
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-8100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 MCCLAIN WAY APT 101
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-8100
Country	:	US
Telephone Number	:	279-204-4133
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	06/04/2026

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