Healthcare Provider Details

I. General information

NPI: 1043036775
Provider Name (Legal Business Name): MICHELE PETERSON LCSW A LICENSED CLINICAL SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27349 JEFFERSON AVE STE 102
TEMECULA CA
92590-5611
US

IV. Provider business mailing address

24329 BAY LAUREL AVE
MURRIETA CA
92562-2163
US

V. Phone/Fax

Practice location:
  • Phone: 619-354-3812
  • Fax:
Mailing address:
  • Phone: 435-817-7004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELE PETERSON
Title or Position: PRESIDENT
Credential: LCSW
Phone: 435-817-7004