Healthcare Provider Details

I. General information

NPI: 1235042490
Provider Name (Legal Business Name): FAITH PETERSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6410 FANNIN ST STE 1217
HOUSTON TX
77030-5311
US

IV. Provider business mailing address

4 CHELSEA BLVD APT 308
HOUSTON TX
77006-6266
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: