Healthcare Provider Details

I. General information

NPI: 1063130375
Provider Name (Legal Business Name): CHRISTOPHER LEE PETERS LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 N LARCHMONT BLVD FL 2
LOS ANGELES CA
90004-3704
US

IV. Provider business mailing address

6431 PRIMROSE AVE APT 1
LOS ANGELES CA
90068-4402
US

V. Phone/Fax

Practice location:
  • Phone: 323-762-5310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number134274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: