Healthcare Provider Details

I. General information

NPI: 1740816966
Provider Name (Legal Business Name): RALPH RICHARD PETERS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICK PETERS LCSW

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12655 WOODFOREST BLVD STE 700
HOUSTON TX
77015-3575
US

IV. Provider business mailing address

12655 WOODFOREST BLVD
HOUSTON TX
77015-3564
US

V. Phone/Fax

Practice location:
  • Phone: 713-453-2300
  • Fax: 713-453-2300
Mailing address:
  • Phone: 713-453-2300
  • Fax: 713-453-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30939
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: