Healthcare Provider Details

I. General information

NPI: 1316963697
Provider Name (Legal Business Name): SUMITH D PETER FERNANDO LPC, LMFT, CCDC, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CENTRAL DRIVE STE 205
BEDFORD TX
76021
US

IV. Provider business mailing address

1901 CENTRAL DRIVE STE 205
BEDFORD TX
76021
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-1420
  • Fax: 817-545-8574
Mailing address:
  • Phone: 817-283-1420
  • Fax: 817-545-8574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number10654LPC
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number98LMFT
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: