Healthcare Provider Details

I. General information

NPI: 1073427647
Provider Name (Legal Business Name): DAWN MICHELLE PETERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 SHADY CEDAR HILL LN
WILLIS TX
77378-1450
US

IV. Provider business mailing address

334 SHADY CEDAR HILL LN
WILLIS TX
77378-1450
US

V. Phone/Fax

Practice location:
  • Phone: 936-933-2679
  • Fax:
Mailing address:
  • Phone: 936-933-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109823
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: