Healthcare Provider Details

I. General information

NPI: 1760586945
Provider Name (Legal Business Name): BILL B PETERS PHD, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E JEFFERSON AVE STE A
WHITNEY TX
76692-2303
US

IV. Provider business mailing address

126 GIANT CEDAR DR.
WHITNEY TX
76692-2253
US

V. Phone/Fax

Practice location:
  • Phone: 254-694-9457
  • Fax: 270-573-7794
Mailing address:
  • Phone: 254-694-0858
  • Fax: 270-573-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS10635
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2511
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: