Healthcare Provider Details

I. General information

NPI: 1396237186
Provider Name (Legal Business Name): PETER STEPHENS PSYD, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25873 HEMET ST
HEMET CA
92544-5026
US

IV. Provider business mailing address

1449 ROLLINGWOOD ST
BEAUMONT CA
92223-3133
US

V. Phone/Fax

Practice location:
  • Phone: 951-765-6955
  • Fax:
Mailing address:
  • Phone: 951-640-9184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: