Healthcare Provider Details

I. General information

NPI: 1033246822
Provider Name (Legal Business Name): WILLIAM PETERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 S OAK KNOLL AVE
PASADENA CA
91101-2611
US

IV. Provider business mailing address

118 S OAK KNOLL AVE
PASADENA CA
91101-2611
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-6907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 41297
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: